Surgical Management of Branch Renal Arterial Disease

Abstract

Vascular disease involving the branches of the renal artery is most often due to one of the fibrous dysplasias, namely intimal, medial, or perimedial fibroplasia [7]. Other causes of branch disease include an arterial aneurysm, arteriovenous malformation, Takayasu’s arteritis, neurofibromatosis, trauma, and, rarelyll, atherosclerosis. The typical clinical presentation for most of these disorders is in children or young adults with recently discovered hypertension. Bilateral renal vascular involvement is frequently observed, particularly with the fibrous dysplasias, and extrarenal vascular lesions may also be present [10, 12]. A decision favoring medical or interventive treatment in such cases is made after evaluating the functional significance of renal artery disease and with regard for the natural history of the particular lesion. The most common indication for undertaking renal vascularization in these younger patients is the presence of significant associated hypertension. Although new medical agents, such as beta-blockers and converting enzyme inhibitors, have proven very effective in treating renin-mediated hypertension, they have no place in the definitive treatment of young patients, since their use would mean lifelong commitment to drug therapy and a significance risk of losing renal function from progressive vascular obstruction. The latter is most likely to occur when renal artery disease is due to intimal or perimedial fibroplasia. Occasionally, resection of a renal artery aneurysm is indicated to obviate the risk of rupture associated with certain clinical features [5, 9].