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Surgical management of adult and pediatric renovascular hypertension
Ist Teil von
Endovascular and Open Vascular Reconstruction, 2018, Vol.1, p.245-255
Auflage
1
Ort / Verlag
CRC Press
Erscheinungsjahr
2018
Link zum Volltext
Quelle
Alma/SFX Local Collection
Beschreibungen/Notizen
Open renal revascularization for arteriosclerotic and fibrodysplastic renovascular hypertension (RVH) in adults has been performed less often in recent years given the advances in endovascular therapy of these diseases. Open surgical treatment of arteriosclerotic renal artery stenoses entails a variety of techniques, including: aortorenal endarterectomy through an axial aortotomy; aortorenal endarterectomy through the transected infrarenal aorta; and an aortorenal bypass. Transaortic renal artery endarterectomy for arteriosclerotic renal artery stenotic disease is often performed in patients requiring a concomitant aortic reconstruction. Aortorenal bypass procedures for both arteriosclerotic and fibrodysplastic renal artery stenoses were the standard of care in many practices during the 1970s. The outcomes of carefully selected patients with renal arteriosclerotic disease undergoing open surgical treatment for their RVH result in 25% cure, 55% improvement, and 20% failure rates, with a reported mortality rate of 3%. Conventional surgical revascularization for pediatric RVH that emphasizes direct renal artery implantation and single-staged concomitant aortic reconstruction offers excellent results.