Renovascular reconstruction: Factors affecting long-term prognosis in 919 patients followed up to 31 years

During the 31-year period from May 3, 1955, to May 12, 1986, renovascular reconstructions were performed on 919 patients. The mean age of the 529 men was 54 ± 0.58 (SE) years and, of the 390 women, 48 ± 0.7 years. Mean preoperative diastolic blood pressure was 110 ± 0.6 mm Hg. The most common causes of renal artery stenosis were atherosclerosis in 647 patients, fibromuscular disease in 161 patients, and renal artery aneurysm in 51 patients. In the remaining 60 patients, other causes were present, including kinks and fibrous bands. The most common surgical procedures were Dacron bypass graft (780 arteries) and endarterectomy with or without a patch graft (329 arteries). Four hundred sixty-nine patients had associated operations, the most common of which were abdominal aortic aneurysmectomy in 231 and aortoiliofemoral reconstruction in 141 patients. The perioperative mortality rate was 5.5% (51 of 919 overall); for renal procedures alone, it was 1.7% (8 of 450) and for combined surgical procedures, 9.2% (43 of 469). The overall graft patency rate at a follow-up of 18.8 ± 1.9 months was 88.6% (381 of 430) and at a second follow-up of 50 ± 4.3 months, 86.7% (111 of 128). Analysis of long-term blood pressure response and factors affecting late survival indicated that patients with preoperative diastolic pressures of >100 mm Hg and renal artery stenosis of >70% had the best blood pressure responses and that male sex, increasing age, bilateral renal stenosis, and associated vascular operations lowered the survival rate whereas fibromuscular disease enhanced the duration of survival. Thus, renal artery reconstruction resulted in sustained good long-term relief of hypertension and preservation of renal function in most patients. Some subgroups of younger patients had better survival rates, but this was not true of the subgroups of the elderly.