RETROSPECTIVE STUDY OF PATIENTS FOLLOWING RENAL REVASCULARISATION PROCEDURES - AN INSTITUTIONAL EXPERIENCE

Aim and Objectives:To study the clinical presentation of patients with renal artery disease and its outcome following revascularisationprocedures . Type of study: Retrospective study Study period: July 2013 to June 2018 Material and Methods: This is a retrospective study we made on eleven patients presented with renal artery disease either as uncontrolled hypertension(>160/100mmHg )or in association with peripheral arterial disease, at the Institute of vascular surgery , RGGGH, Chennai. These patients were subjected for open or endovascular revascularisation procedures depending on their clinical characteristics and the type of disease. Following revascularisationprocedures , these patients were followed up at 2nd week, 1st month, 3rd month and 6th monthly thereafter during the study period and the outcomes are analysed and tabulated here to present our institutional experience. Inclusion criteria: 1. Renal artery stenosis with uncontrolled HTN (>160/100mmHg) on >3 antihypertensive drugs. 2. Renal artery stenosis with recurrent episodes of pulmonary edema 3. Renal artery stenosis with Peripheral arterial disease causing life stye limiting claudication pain or CLI Exclusion criteria: 1. Renal artery stenosis with normotensive Blood pressure(<140/90mmHg) on medication 2. Renal artery stenosis with preserved renal function as estimated by GFR(90ml/min) . Results: In this retrospective study on 11 patients with renal artery stenosis, 7 were women and 4 were men. Amongst the 7 women, 5 of them presented with uncontrolled HTN secondary to Takayasuarteritis , 2 of the remaining patients presented with 2 episodes of flash pulmonary edema HTN with atherosclerotic disease associated RAS. Amongst the 4 men, 3 of them presented with RAS secondary to atherosclerosis with recurrent pulmonary edema while on antihypertensive medications and one patient was diagnosed to have Fibromuscular dysplasia with RAS and uncontrolled HTN while on 4 antihypertensive medications. All 5 women with Takayasu arteritis were managed with renal artery angioplasty , off these 2 of them were done aortoplasty for Mid aortic syndrome in the same sitting .The remaining 2 women were treated with aortobirenal bypass using synthetic graft for atherosclerotic renovascular hypertension . Amongst the 4 men, 2 of them were subjected for aortorenalendarterectomy with Aortobifem bypass for atherosclerotic disease with disabling claudication pain in 1 and critical limb ischemia in the other, one male patient with atherosclerotic disease was done aortounirenal bypass using synthetic graft for atherosclerotic renovascularhypertension . The remaining one male patient with renovascular hypertension secondary to Fibromuscular dysplasia was done renal artery angioplasty but during follow up period he developed pulmonary edema with uncontrolled hypertension while on 2 antihypertensive medications subsequently patient was managed with aortobirenal bypass using hypogastric artery and synthetic graft as conduit. In the follow up period ,all patients showed improvement in the control of hypertension in the immediate post op period , 2 patients among the takayasu arteritis group needed immunosuppressant therapy for control of disease activity, 1 patient developed restenosis ended up in need for reintervention and the remaining 2 patients had good control of hypertension with single medication. All 5 atherosclerotic renovascular hypertensive patients showed good improvement in hypertension control and no recurrence of pulmonary edema in the follow up period. One patient with Fibromuscular dysplasia associated renovascular hypertension following surgical revascularisation became free off antihypertensive medications.