Rutherford's 128: Renovascular Disease: Open Surgical Treatment скачать в хорошем качестве

Rutherford's 128: Renovascular Disease: Open Surgical Treatment

#RenovascularDisease #RenalArteryStenosis #OpenSurgery #VascularSurgery #Hypertension #KidneyFunction #Dialysis #Rutherford #Treatment This summary details the role of open surgical treatment for Renovascular Disease (RVD), focusing on Atherosclerotic Renal Artery Stenosis, drawing from Rutherford's Vascular Surgery text. While endovascular techniques are common, open surgery remains crucial for specific, carefully selected patients, aiming to improve long-term survival and prevent dialysis. The decision for open repair hinges primarily on the severity of the disease and its impact. Key indicators for considering open surgery include severe, difficult-to-control hypertension, very tight blockages (90%) or complete blockages affecting arteries to both kidneys or a single kidney, and rapidly worsening kidney function. Patients with severe hypertension often see the most benefit. A notable outcome in the authors' experience is that 70% of carefully selected patients already on dialysis could permanently stop treatment after successful open repair. Open surgery is generally not recommended for mild, asymptomatic narrowing or mild hypertension. It is also considered for certain non-atherosclerotic causes and renal artery aneurysms. The goal of surgery is typically to fix all significant renal artery problems in one procedure. Techniques include aortorenal bypass (often using saphenous vein), thromboendarterectomy (cleaning plaque), and reimplantation (moving the artery's connection). Complex cases involving branch arteries may require ex vivo reconstruction, operating on the kidney outside the body, which necessitates cooling to protect it. A critical step is intraoperative assessment, with duplex ultrasound being the preferred method to ensure a technically flawless repair, crucial for long-term success. The authors' significant experience shows low rates of post-operative blockages (3.3%) and good outcomes in selected patients, with high rates of blood pressure improvement and kidney function recovery. Patient selection and meticulous technique are paramount to achieving these results.