Aortorenal vein graft stenosis causing recurrent hypertension

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Although hypertension caused by fibrous or atherosclerotic lesions of the renal arteries may be successfully managed in selected patients by aortorenal revascularization with the use of autogenous saphenous vein grafts, serial angiographic studies in some instances have demonstrated late degenerative changes such as graft dilatation, aneurysm formation, and segmental stenosis. Dilatation has been documented in 20% to 44% of saphenous vein grafts,1, 2 but the functional significance of dilatation is presently unknown, since it has not been consistently associated with aneurysm formation or recurrent hypertension. In comparison, vein graft stenosis occurred in 17% of the series of 94 patients described by Dean et al1 and required reoperation for renal salvage in 9% of the series of 91 cases reported by Stanley et al.2

Unless fibrous hyperplasia involves multiple renal arteries or extends into segmental branch vessels, intraoperative renal perfusion is rarely necessary during primary aortorenal revascularization since warm ischemia time during construction of the distal renal artery anastomosis usually does not exceed 15 to 20 minutes. Temporary renal perfusion during reoperative procedures may be considerably more important, however, since prolonged occlusion of the distal renal artery may be required. We report a simple method of renal perfusion we have used during reconstruction of an aortorenal vein graft stenosis that had caused recurrent hypertension.

Case report

A 38-year-old woman first became hypertensive in September 1972 at the age of 31. The blood pressure at the time of diagnosis was 170/110 mm Hg and the sustained elevation of diastolic blood pressure at . . .



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