Ex Vivo Arterial Repair for Renovascular Hypertension Secondary to Fibrodysplasia

Therapy

Surgical reconstruction is considered the gold standard of therapy for renal fibrodysplastic lesions. Operative morbidity and mortality rates in these young patients are very low, and excellent long-term functional results up to 15 years or more have been reported by many. A variety of surgical techniques have been used for surgical revascularization for repair of stenosis in the main renal artery. Lesions extending into the renal arterial branches can be repaired by both in situ and ex vivo techniques. In these circumstances, we prefer extracorporeal reconstruction and autotransplantation of the kidney.

The advantages of ex vivo reconstruction are optimal exposure, a bloodless surgical field, protection of the kidney from prolonged warm ischemia, no time limit for microvascular repair, and contraction of the kidney resulting from preservation, which allows an easier dissection. Finally, the complete reconstruction can be tested for both patency and leakage before implantation. Compared with in vivo repair, ex vivo repair is associated with longer operation times, more blood loss, and more wound hematomas. Although it has been suggested that stenosis at the renal bifurcation can be repaired in situ, results of extracorporeal repair appear to be superior. Standard indications for performing ex vivo arterial repair exist ( Box 1 ).