Donald J. Breslin

Renal Revascularization to Preserve and Restore Renal Function

A total of 97 patients underwent 107 renal revascularization procedures for restoration and preservation of renal function. Of the 4 groups of high risk surgical patients that emerged an overall successful outcome was achieved in 83%, with a 6% mortality rate and an 11% morbidity rate. Renal revascularization for restoration and preservation of renal function can be performed safely with good results. The preoperative serum creatinine level was not predictive of the surgical outcome. Alternative bypass procedures are preferred.

Hepatorenal Artery Bypass in the Management of Renovascular Hypertension

Infrequently, when the aorta cannot be used for a standard renal bypass operation because of a previous aortic operation, severe degenerative atherosclerosis or complete aortic thrombosis, a unilateral (hepatic) or bilateral (hepatic and splenic) visceral bypass should be contemplated. Patients with abdominal aortic aneurysms extending above the renal arteries might benefit from concomitant bilateral visceral bypass procedures followed by aortic replacement during the same operative session. The hepatic circulation with its common anatomic variations, indications, surgical technique and effects of hepatorenal artery bypass on the renal and hepatic circulation are discussed.

Predictability of surgical cure of renovascular hypertension.

Seventy-five patients with renal artery stenosis were studied; 50 patients had unilateral lesions and 25 had bilateral lesions. Divided renal vein renins and peripheral renins were collected under strict salt intake, drug intake, and postural conditions. Divided renal vein renin ratios and a scoring system that included peripheral renin and affected and contralateral renal secretion of renin were applied to each patient and compared in each to the patients ultimate surgical result. Both methods, if positive, are highly predictive of cure in patients with renal artery disease. Both methods are plagued by significant false-negative rates, 20% for renal vein ratio, 33% for the scoring system in patients with unilateral stenosis, and 35% and 48%, respectively, in patients with bilateral renal artery stenosis. For these reasons, surgical selection should be based on evaluation of a combination of the clinical presentation, angiographic findings, and renin data.

Diseases of the Aorta and Arterial Tree

Diseases of the aorta and arterial tree in the elderly are common and most often are complications of atherosclerosis. These conditions frequently are potent markers of severe coronary artery disease and should prompt careful cardiac evaluation. Although a single pathologic disease is present, clinical manifestations are diverse and depend on the particular expression of atherosclerosis (aneurysm formation, stenosis, and occlusion or embolism) and on its specific anatomic location (thoracic aorta and its cervical and intracranial branches, or abdominal aorta and its visceral and extremity branches).

Diseases of the Aorta and Arterial Tree in the Elderly

Diseases of the aorta and arterial tree in the elderly are common and most often are complications of atherosclerosis. These conditions frequently are potent markers of severe coronary artery disease and should prompt careful cardiac evaluation. When a single pathologic disease is present, clinical manifestations are diverse and depend on the particular expression of atherosclerosis—aneurysm formation, stenosis, and occlusion or embolism—and on its specific anatomic location thoracic aorta and its cervical and intracranial branches or abdominal aorta and its visceral and extremity branches.