What is the role of bypass procedures in the treatment of renal artery stenosis (RAS)?

Updated: Nov 02, 2020
  • Author: Bruce S Spinowitz, MD, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Bypass procedures include aortorenal, hepatorenal, splenorenal, and ileorenal conduits constructed with autologous saphenous veins, autologous arteries, or prosthetic material. For atherosclerotic disease, surgeons can also perform atherectomy to improve renal blood flow. In persons with nonatheromatous renal artery disease, surgeons can reconstruct the renal arteries ex vivo and then can reimplant the revascularized kidney. Reilly and coworkers reported an operative mortality rate of only 6% and immediate improvement in the serum creatinine level of 32% of surgical bypass procedures in 35 patients with solitary kidneys. [33]

Subsequent studies reported more consistent success. The largest series suggests that the glomerular filtration rate (GFR) improved postoperatively in 49-80% of patients with underlying renal failure.

Guidelines from the American Heart Association/American College of Cardiology and the European Society of Cardiology include recommendations for the use of peripheral revascularization and surgical revascularization. See Guidelines.

 


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