Prophylactic repair of renal artery stenosis is not justified in patients who require infrarenal aortic reconstruction

Purpose: Simultaneous prophylactic repair of asymptomatic renal artery stenosis (RAS) in patients who need infrarenal aortoiliac reconstruction is controversial. This study documents the natural history of asymptomatic RAS in patients who need aortic reconstruction. Methods: Two hundred patients who needed aortic reconstruction from 1985 to 1990 for indications other than hypertension or renal salvage were identified. Asymptomatic RAS was not repaired. Preoperative angiograms were available for 171 of 200 patients and were reviewed for renal artery stenosis. Patients were assessed for atherosclerotic risk factors, survival, preoperative and follow-up blood pressure, serum creatinine level, antihypertensive medication use, and need for dialysis. Results: The mean duration of follow-up was 6.3 years. Twenty-four of 171 patients (14%) had preoperative unilateral 70%-99%-diameter-reduction asymptomatic RAS, and eight (5%) had bilateral 70%-99%-reduction asymptomatic RAS. Clinical features associated with asymptomatic RAS of 70% reduction and above included coronary artery disease, increased age, and a diagnosis of hypertension (P < .05). Patients with asymptomatic RAS of 70% reduction and above did not have a decreased 7-year survival rate (66% vs 84%, P = .10) but had higher systolic blood pressures (153 mm Hg ± 25 vs 138 mm Hg ±30, P < .05) and increased numbers of antihypertensive medications at follow-up (1.1 ±0.2 vs 0.7 ±l, P < .05). The mean scrum creatinine level (1.1 mg/dl. ±0.3 preoperative vs 1.4 mg/dl. ±0.8, not significant) was not increased. One patient (0.58%) with polycystic kidney disease and minimal RAS needed dialysis. Conclusions: High-grade asymptomatic RAS in patients who are undergoing infrarenal aortic reconstruction is associated at late follow-up with increased systolic blood pressure and a need for increased numbers of antihypertensive medications but not with a decreased survival rate, dialysis dependence, or an increase in serum creatinine level. These data do not support renal artery repair in patients with asymptomatic RAS who undergo infrarenal aortic reconstruction.