Alternative Methods of Renal Revascularization

Saphenous vein aortorenal bypass is the most commonly used surgical procedure for relief of renovascular hypertension. Years of experience have shown the procedure to be effective with satisfactory long-term results. Coexisting disease conditions of the aorta sometimes make alternative methods of renal revascularization preferable, especially when more than one renal artery is involved. Such alternative procedures include transaortic endarterectomy, bilateral renal endarterectomy via a transverse incision across both renal arteries, or extra-anatomic bypass from the splenic, hepatic, or iliac arteries. Two hundred twenty-five renal revascularization procedures performed either alone or in combination with other abdominal vascular procedures during the last 5 years is reported. In 18 patients, one of the above procedures was performed. This experience with these various types of renal revascularization will be discussed with particular reference to indications, technique, and potential pitfalls of each procedure.