Isolated spontaneous dissection of the renal artery (ISDRA) is an uncommon cause of arterial hypertension. In our experience, it accounts for 1.5 % of our surgical reconstructions of the renal artery

Purpose : The aim of this study was to present a homogeneousseries of isolated spontaneous dissections of the renal artery operatedon by the same surgeon, to assess the feasibility of renal arteryreconstruction and to study the results of surgical treatment. Extensionof an aortic dissection to the renal arteries as well as dissectionscomplicating transluminal angioplasty were excluded.Patients and Methods : During a 21-year period (1978-1998), 22patients (17 men, 5 women) with spontaneous dissection of therenal artery were operated on. Their mean age was 41 ± 8.4 years.All patients presented with uncontrollable arterial hypertension ofrecent and abrupt onset. In ¾ of them, the initial symptom was lumbaror flank pain. These patients underwent the usual investigationsperformed in subjects with hypertension. Arterial opacification wascarried out with standard abdominal aortography or intra-arterialdigital angiography in the majority of the cases. Recent imagingtechniques (scan 3 D, angio MRI) will probably replace the formerinvestigations in the future (figure 1). Diagnosis was sometimesdifficult when radiological images were atypical. Due to bilaterallesions (3 patients) or combined operation (1 patient), surgicaltreatment consisted of 8 nephrectomies (6 total, 2 partial) and 17arterial repairs (in 16 patients) carried out by conventional in situsurgery (6 cases) or by extracorporeal repair (11 cases). The highrate of the latter technique was due to the severity of the lesionswith frequent extension to several terminal branches of the artery(ies).Results : There was no postoperative mortality or morbidity inthis series. Arterial hypertension was cured in 9 patients (41 %),improved in 11 (50 %) and unchanged in 2 (9 %). The anatomicalresults of repairs were excellent in 13 patients (81 %) (figures 2, 3and 4) and incomplete in 3 (19 %), because of renal remainingdamages (segmental atrophy, notching, irregularities of renal parenchyma).During long-term follow-up, 1 late thrombosis of arepaired polar artery (at 2 years) and 1 spontaneous dissection ofthe contralateral renal artery (at 5 years) occurred; the latter patientwas successfully treated with anti-hypertensive drugs. In 8patients, late angiographies showed that the results of reconstructionsremained stable with time. Two patients had impaired renalfunction before the operation. Serum creatinine level was slightlyelevated in one patient (170 ?g/L) and rose to 400 ?g/L in theother. The first patient regained normal renal function after repairof the renal artery. In the other, renal function remained slightlyimpaired (serum creatinine of 140 ?g/L) but stable for 10 years.Conclusions : Surgical treatment of isolated spontaneous dissectionof the renal artery is indicated in patients presenting withsevere uncontrollable hypertension in spite of heavy medical treatment.Arterial repair is the ideal treatment. It is often possibleeven when complex lesions are present. In such cases ex vivosurgery affords great safety and ease of repair. Results concerningcontrol of hypertension are satisfactory. Anatomical results remainstable with time.