Adam H. Power, Thomas C. Bower, Manju Kalra, Audra A. Duncan, Gustavo S. Oderich, Robert McBane, Eddie Greene, Peter Gloviczki
Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
OBJECTIVES: Isolated spontaneous dissection of the renal artery (ISDRA) is rare and the preferred treatment is undefined. Open and endovascular approaches have had mixed results and there is little data on nonoperative management. Our objective was to assess the management of ISDRA with emphasis on those treated without operative intervention.
METHODS: All patients with ISDRA were reviewed at a single institution from 1995 to 2010.
RESULTS: Forty-three patients were treated with 55 ISDRA. Thirty-five were males (81%), 41 were Caucasian (91%), and the mean age was 46.2 years (range, 29-72). Forty-one patients presented with abdominal or flank pain (95%) and only 3 had pre-existing hypertension (7%). The mean time from symptoms to diagnosis was 7.8 days (range, 1-60). Initial mean creatinine (Cr) was 1.1 mg/dL. Most patients were diagnosed with computed tomography (n=39, 91%). No other dissections were initially identified based on available imaging studies. The dissection involved the main renal artery in 44 (80%), a segmental branch in 40 (73%), and ipsilateral multiple branches in 23 (42%). Thirty-seven patients (67%) had a minor infarct (<25% of cortex), 9 (16%) moderate (25-50% of cortex), and 2 (4%) severe (>50% of cortex). All but one patient were treated nonoperatively, using anticoagulation in 36 patients (86%) for a mean duration of 5.7 months (range 1-24), life-long aspirin therapy in 29 (69%), and blood pressure control in 35 (83%). An attempt at ex-vivo repair in the operative patient failed. Thirty-four patients (81%) developed new onset of HTN within 1 year and were on 1.1 (range, 0-3) antihypertensive medications at 1 year. Three patients (7%) had a recurrent dissection, 41 (98%) had a normal creatinine, and no patient died or required dialysis over a mean follow-up of 35 months (range 0-279).
CONCLUSIONS: Nonoperative management of ISDRA is feasible and safe in most patients.
AUTHOR DISCLOSURES: T. C. Bower, Nothing to disclose; A. A. Duncan, Nothing to disclose; P. Gloviczki, Nothing to disclose; E. Greene, Nothing to disclose; M. Kalra, Nothing to disclose; R. McBane, Nothing to disclose; G. S. Oderich, Nothing to disclose; A. H. Power, Nothing to disclose.
Posted April 2012