Réinterventions après angioplastie ou chirurgie de l'artère rénale

Over the past 15 years, our service performed 833 renal transplants, 267 open renal arterial revascularizations and 315 percutaneous renal arterial dilations. During the same interval, 41 patients (5 children, 22 men and 14 women with a mean age of 49 years) required a second surgical intervention after failure of an initial percutaneous dilation, primary revascularization or because of a vascular complication on a transplanted kidney. Ten of these patients were anuric and 22 had a serum creatinine greater than 200 mmoles. All 41 were hypertensive. There were not perioperative deaths. In the immediate postoperative period, 4 patients required temporary dialysis for 3 weeks to 2 months, while 2 others remained on chronic dialysis. Long term follow-up averages 64 months. Five patients were lost to follow-up and 6 others died, a man 3 years after the second intervention. Among the 30 surviving patients available for study, 6 additional ones are under chronic dialysis (for a total of 20% of the patients reoperated upon). Only 3 patients were cured of their hypertension, while the others are adequately medically managed. In this series which includes 5 children, three had an initial aortorenal bypass and 2 others double angioplasties. Three required reoperation twice. These numbers argue in favor of autotransplantation or autologous reconstruction as an initial management strategy.