Use of the hepatic circulation for renal revascularization.

Aortorenal bypass is the preferred procedure for renal revascularization. Occasionally the aorta cannot be used safely and an alternative procedure is required. Thirty-six patients (21 from the Lahey Clinic and 15 from the Cleveland Clinic) have undergone hepatorenal bypass procedures when confronted with a difficult aorta and right renal artery stenosis. Twenty men and 16 women were operated on and observed from 1 to 9 years. The medical indications for surgery were uncontrollable hypertension in 14 patients, preservation of renal function in eight patients, and a combination of these entities in 14 patients. The surgical indications that required an alternate bypass were diffuse atherosclerotic aortic disease in 24 patients, abdominal aortic aneurysms in six patients, and previous aortic surgery in six patients. Postoperative hepatic function studies were assessed in all patients. No permanent abnormalities of liver function were attributed to surgery. Hypertension was cured or improved in 93% of patients; 7% were unresponsive. Mean creatinine levels were 3.5 mg/dl before operation and 2.1 mg/dl after operation. Renal revascularization was successful in 33 of 36 patients (92%).