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Biomedical subjects

B B Chang

Publications and source records attributed to B B Chang.

At least 19 recordsLinked to original sources
PubMed1998

Proximal promoter sequences mediate cell-specific and elevated expression of the favorable prognosis marker TrkA in human neuroblastoma cells.

The nerve growth factor receptor, TrkA, has a critical role in the survival, differentiation, and function of neurons in the peripheral and central nervous systems. Recent studies have demonstrated a strong correlation between abundant expression of TrkA and a favorable prognosis of the pediatric tumor, neuroblastoma. This correlation suggests that TrkA may actively promote growth arrest and differentiation of neuroblastoma tumor cells and may be an important therapeutic target in the treatment of this disease. In the present study, we have examined the mechanistic basis for TrkA gene expression in human neuroblastoma cells. Northern blotting and nuclear run-on analyses demonstrated that transcription is a primary determinant of both cell-specific and variable expression of the TrkA gene in neuroblastoma cell lines that express it to different degrees. Cell-specific and variable transcription in neuroblastoma cells was recapitulated by transient transfection of TrkA promoter-luciferase reporter constructs, and regulatory sequences mediating these processes were localized to a 138-base pair region lying just upstream of the transcription initiation region. This neuroblastoma regulatory region formed multiple DNA-protein complexes in gel shift assays that were highly enriched in neuroblastoma cells exhibiting abundant TrkA expression. Thus, TrkA-positive neuroblastoma cells are distinguished by differential expression of putative transcription factors that ultimately may serve as targets for up-regulating TrkA expression in tumors with poor prognosis.

Humans↗
PubMed1998

Combined carotid endarterectomy and coronary artery bypass grafting does not increase the risk of perioperative stroke.

Patients who present for coronary artery bypass grafting with hemodynamically significant carotid artery lesions pose a difficult problem for both the cardiac and vascular surgeons. There is no consensus as to the proper management of these patients despite numerous studies. Prospective collection of data was performed in patients undergoing combined carotid endarterectomy and coronary artery bypass grafting's from April 1980 to November 1996. A total of 470 simultaneous carotid endarterectomy's and coronary artery bypass grafting's were performed in 420 patients. The average age of the patient was 69 years, with 62% being male, 15% being diabetic and 38% being smokers. Sixty (13%) presented with Transient ischemic attacks, 22 (5%) presented with amaurosis fugax, 16 (3.4%) presented with a prior history of stroke and 372 (70%) were asymptomatic. Operative mortality was 2.4% or 10 patients; 90% of those patients died from cardiac complications postoperatively and one patient died of a stroke. Permanent neurological deficits occurred in five (1%) of the patients, and six (1.7%) of the patients had a transient neurological deficit that improved prior to discharge. In conclusion, in our experience simultaneous carotid endarterectomy with coronary artery bypass grafting can be performed with an acceptable mortality and morbidity and does not appear to put the patient at a higher risk than when either procedure is performed alone.

Aged↗
PubMed1998

Carotid endarterectomy by eversion technique: its safety and durability.

SUMMARY BACKGROUND DATA: The outcome of standard longitudinal carotid endarterectomy (CEA) can be measured by preservation of neurologic function with a low incidence of restenosis. Closure of the internal carotid arteriotomy with or without a patch may predispose to restenosis. Alternatively, transection of the internal carotid artery at the bulb with eversion endarterectomy allows expeditious removal of the plaque and direct visualization of the endpoint. Because the proximal internal carotid artery is anastomosed to the common carotid artery, this obviates the need for patch closure. The authors report their results with this technique in more than 2200 procedures. METHODS: From May 1993 to March 1998, 1855 patients underwent 2249 CEAs using the eversion technique. During the same period, 410 patients had 474 CEAs by standard technique. Three hundred fifteen procedures in the eversion group and 65 procedures in the standard group were combined CEA and coronary artery bypass grafts. Most solo CEAs (97%) were performed in awake patients using regional anesthesia. Shunts were used on demand in 6% of CEAs. RESULTS: The operative mortality rate was 1.02% (16/1575) in the solo eversion group and 2.2% (9/410) in the standard group. There were 18 permanent neurologic deficits (0.8%) in the eversion group and 11 (2.3%) in the standard group. Transient neurologic deficits occurred in 20 patients (0.9%) in the eversion group and 13 patients (2.7%) in the standard group. Of the 1855 patients, 1786 (96%) presented for duplex ultrasound follow-up. There were seven (0.3%) stenoses greater than 60% in the eversion group versus five (1.1%) in the standard group. CONCLUSIONS: Eversion CEA can be performed safely with a low rate of stroke and death and a minimal restenosis rate in short- and long-term follow-up.

Adult↗
PubMed1997

The performance of femoropopliteal bypasses using polytetrafluoroethylene above the knee versus autogenous vein below the knee.

BACKGROUND: Controversy exists as to the choice of conduit for the treatment of superficial femoral artery occlusive disease, particularly when a patent above-knee popliteal artery exists. Some surgeons advocate the preferential use of polytetrafluoroethylene (PTFE), whereas others favor the use of autogenous vein. This report compares our experience with above-knee femoropopliteal bypass with PTFE versus below-knee femoropopliteal bypass with autogenous vein. METHODS: This study covers a 15-year period extending from 1982 to 1996 during which 1,313 arterial reconstructions were performed for superficial femoral and/or proximal popliteal arterial disease. Four hundred and thirty-eight procedures were performed to the above-knee popliteal artery using PTFE, and 875 procedures were performed to the below-knee popliteal artery using autogenous vein. The indication for surgery was limb salvage in 77% of patients in the PTFE group and 88% of patients in the vein group. RESULTS: The 1-, 3-, and 5-year cumulative life table primary patency rates for the PTFE group were 74%, 56%, and 50%, respectively. The primary patency rates for the vein bypass group were 83%, 75%, and 67%, respectively (P < 0.01). The 5-year cumulative limb salvage rates were 91% and 95% for the PTFE and vein groups, respectively (P = NS). CONCLUSIONS: In this series, below-knee femoropopliteal venous reconstructions have superior patency rates compared with above-knee femoropopliteal PTFE reconstructions. Venous reconstruction for femoropopliteal occlusive disease gives the optimal long-term result. Prosthetic reconstruction should be considered for patients with limited venous conduit or decreased life expectancy.

Adult↗
PubMed1997

Timing of carotid endarterectomy in patients with recent stroke.

BACKGROUND: There is little objective data to support the conventional wisdom of waiting 4 to 6 weeks after stroke to improve surgical outcome of subsequent carotid endarterectomy (CEA). We have aggressively pursued CEA in patients after recent stroke; in this study we report our results. METHODS: We performed 215 CEA procedures in 200 patients who presented with an indication of stroke within 6 months of CEA. Cervical block anesthesia was used 193 cases. The rest were performed with the patient under general anesthesia. RESULTS: Perioperative stroke rate was 1.4% (3/215), and operative mortality was 2% (4/200) (stroke mortality = 3.4%). There were four early occlusions. Shunts were used in 13.9%, patch closure in 8.4%, and eversion endarterectomy in 48% of cases. There was no correlation between timing of surgery, extent of infarct on computed tomography/magnetic resonance imaging, and postoperative neurologic complications with the occurrence of postoperative stroke (p = NS). During the same period, 1,922 patients underwent CEA for indications other than stroke, with a perioperative stroke rate and mortality rate of 1.1%. CONCLUSIONS: Selected patients presenting with a history of stroke and significant carotid artery disease can safely undergo early CEA with a mortality and morbidity comparable to patients undergoing CEA for other indications.

Carotid Stenosis↗
PubMed1997

A prospective randomized study comparing exclusion technique and endoaneurysmorrhaphy for treatment of infrarenal aortic aneurysm.

PURPOSE: The retroperitoneal approach used in aortic replacement for infrarenal aortic aneurysm has become an important part of the vascular surgeon's armamentarium. Use of the exclusion and bypass technique, however, remains controversial. Although benefits may include reduced blood loss, less operative dissection, and a smoother intraoperative and postoperative course, critics of this technique have alluded to potential drawbacks. In this study the results of the exclusion technique and open endoaneurysmorrhaphy for surgical treatment of abdominal aortic aneurysm were compared. METHODS: One hundred patients were randomized to either exclusion (EXC) or open endoaneurysmorrhaphy (OP) procedures. A posterolateral left retroperitoneal approach was used in all patients. During surgery, autotransfusion devices were used when needed. Doppler flow and pressures in the excluded aneurysm sac were determined during surgery in EXC to evaluate the completeness of the exclusion. RESULTS: Patient demographics were similar between the two groups. The mean age was 70 years (range, 53 to 89 years). The operative mortality rates were 0% and 1.9% (1 of 51) in the EXC and OP groups, respectively. Nonfatal postoperative complications occurred in 10.2% (5 of 49) of the EXC group and in 23.5% (12 of 51) of the OP group (p < 0.05). Aneurysm sacs were opened in two EXC procedures. Blood loss (mean +/- SD) was 703 +/- 570 ml in the EXC group and 1031 +/- 703 ml in the OP group (p < or = 0.01). The intensive care unit stay (mean +/- SD) was 1.9 +/- 1.2 days in the EXC group and 3.2 +/- 6.9 days in the OP group (p = NS). The hospital stay (mean +/- SD) was 9.8 +/- 5.8 days and 12.1 +/- 17 days in the EXC and OP groups, respectively (p = NS). There has been persistent flow in the excluded sac in two patients, with sac enlargement in one of these patients on postoperative follow-up by duplex scan or clinical examination. CONCLUSION: The exclusion and bypass technique for repair of infrarenal aortic aneurysm appeared to be an acceptable technique and was associated with less operative blood loss and fewer postoperative complications than those of open aortic endoaneurysmorrhaphy. Exclusion bypass may contribute to a smoother perioperative course and postoperative treatment of these patients.

Aged↗
PubMed1997

Alternative approach for management of infected aortic grafts.

PURPOSE: Prosthetic infection after aortic reconstructive surgery historically has been treated with extraanatomical bypass, graft excision, and aortic stump closure, but at the cost of substantial mortality and amputation rates. Alternatives to this strategy include in situ prosthetic replacement in the infected area, as well as autogenous reconstructions. Inherent to all of these procedures, however, is either the creation of an aortic stump, which carries a significant risk of subsequent blowout, or the placement of a bypass conduit in the infected field, thereby maintaining the potential for subsequent infectious complications. To avoid such problems, we have used retroperitoneal in-line aortic bypass with polytetrafluoroethylene through dean tissue planes. METHODS: Since 1987 we have treated 16 graft infections in this manner. The surgical approach consisted of obtaining retroperitoneal proximal aortic control outside of the infected field (above or below the renal arteries), followed by infrarenal division and oversewing of the distal aorta. A polytetrafluoroethylene bifurcated graft was then sewn to the proximal aorta and tunnelled through the psoas sheath laterally to the profunda femoris artery on the ipsilateral side and via the space of Retzius to the contralateral appropriate femoral vessel, so as to avoid any contact with the infected areas. After the closure of the wounds, a plastic barrier was placed over all incisions and the patient was placed supine. The old infected graft was removed transperitoneally. Extensive cultures were taken at various sites to demonstrate no cross-contamination. RESULTS: All patients were followed-up clinically and with tagged white cell scans at 6-month intervals. There were no immediate postoperative deaths and no amputations. One patient had a myocardial infarction and died at 5 months, and a second patient died at 2 months. Of the remaining 14 patients, none had recurrent sepsis and all have had negative Indium-labeled white cell scans in follow-up. Eleven (78%) are still alive, with a mean follow-up of 32 months (range, 20 to 106 months). CONCLUSIONS: In-line aortic bypass for treatment of aortic graft infections yields excellent results and has become our treatment of choice in dealing with this difficult problem.

Aged↗
PubMed1997

A critical approach for longitudinal clinical trial of stretch PTFE aortic grafts.

Adaptation of new clinical products should be based upon thorough scientific evaluation of properties and performance in vitro and in vivo. Developmental animal research experimentation is classically carried out by the manufacturer with eventual government approval. However, objective data needs to be recorded during clinical trials including handling characteristics, bleeding, tensile strength, kinking, seamline break, dilatation, anastomotic deterioration, patency, and incorporation. Since April 1991, 1010 stretch polytetrafluoroethylene (PTFE) aortic grafts have been implanted at our institution and data were recorded prospectively. Six hundred and seven were for elective abdominal aortic aneurysms, 46 for symptomatic abdominal aortic aneurysms, 58 for ruptured abdominal aortic aneurysms, 17 for elective thoracoabdominal aneurysms, 3 for ruptured thoracoabdominal aneurysms and the remainder were for various aortoiliac pathology. Average age of the patients was 69 (range: 10-95), 66% were males, 25% were diabetics. Overall operative mortality was 5.8% (2.9% in elective cases and 26.6% in emergent cases). There were 23 occlusions; 21 were revised and 2 were replaced with axillofemoral bypasses. Estimated blood loss was 784 cc in elective cases and 1918 cc in emergent cases. Grafts were followed by duplex ultrasound or CT scan every 3 months during the first year and every 6 months thereafter. There were no graft dilatations or false aneurysms in this series. There was one graft infection and no perigraft seromas or anastomotic deteriorations during this follow up. Follow up was complete in 94% of these patients. In conclusion, stretch PTFE graft has acceptable handling characteristics, no excessive bleeding at the suture line and had no anastomotic or graft dilatation. This graft material was suitable for thoracic, visceral, renal and abdominal aortic reconstructions.

Adolescent↗
PubMed1997

Choice of peroneal or dorsalis pedis artery bypass for limb salvage.

BACKGROUND: Arterial reconstructions performed for limb salvage have increasingly used peroneal and dorsalis pedis arteries as outflow vessels. However, there have been few published reports comparing the patency and limb salvage of these alternative outflow tracts. In this report, we have examined our experience with the peroneal and dorsalis pedis artery bypasses for limb salvage. METHODS AND MATERIALS: During a 19-year period, more than 3,500 infrageniculate reconstructions were performed for limb salvage at our institution. Eight hundred and eighty were performed to the peroneal artery and 291 were performed to the dorsalis pedis. Patients' demographics were similar in both groups. Sixty-three percent of patients were male and 52% were diabetic. All surgeries were performed for patients with critical ischemia. In situ technique was used in 68% of peroneal reconstructions and 66% of dorsalis pedis bypasses, respectively. Translocated veins were used in 28% of bypasses and spliced veins were used in 32%. RESULTS: Secondary patency rates to the peroneal reconstructions were 89% and 76% at 1 and 5 years, and 88% and 68% for the dorsalis pedis bypasses, respectively. No statistical difference was found. Sixteen (1.8%) of peroneal artery reconstructions were hemodynamic failures and four (1.4%) were hemodynamic failures in the dorsalis pedis group. Wound complications were observed in 19 (2.2%) of the peroneal group and 7 (2.4%) of the dorsalis pedis group. Limb salvage rates for the peroneal artery are 96% and 93% at 1 and 5 years, respectively, and 95% and 87% for the dorsalis pedis reconstructions, respectively. CONCLUSION: This experience indicates that both peroneal and dorsalis pedis artery reconstructions have acceptable patency and limb salvage rates. Selection of one of these two outflow tracts, when a choice exists, may depend on the conduit limitation and the adjacent tissue infection. However, both outflow tracts are durable and hemodynamically effective for limb salvage.

Arteries↗
PubMed1996

Beneficial effects of hypertonic mannitol in acute ischemia--reperfusion injuries in humans.

Acute ischemia-reperfusion of extremities is characterized by edema, compartment syndrome and neuromuscular dysfunction. Intravenous hypertonic mannitol has been shown to be of benefit in several experimental models. The authors' 5-year experience with the use of hypertonic mannitol and the treatment of acute ischemia reperfusion injuries in humans has been reviewed. Some of 186 patients with acute arterial occlusion following thromboembolism (149) and trauma (37) were treated. Hypertonic mannitol (25 g intravenous bolus followed by 5-10 g intravenous/h) was given perioperatively. Length of preoperative ischemia varied from 1 to 24h. Some of 57.5% of patients had preoperative neuromuscular dysfunction. Following revascularization, limb salvage was obtained in 97.7% of surviving patients and neuromuscular dysfunction improved in 89%. Overall, 15% required fasciotomy. The mortality rate was 3.2%. These data suggest that hypertonic mannitol may have some protective effect in acute ischemia-reperfusion injuries of human extremities. It may decrease the need for fasciotomy and minimize neuromuscular dysfunction.

Adolescent↗
PubMed1996

Carotid artery bypass in acute postendarterectomy thrombosis.

BACKGROUND: Carotid endarterectomy has demonstrated excellent results over the past 2 decades with combined stroke mortality of < 4% in most active centers. However, the optimal technique for surgical reconstruction for patients with acute postoperative deficits is more controversial. PATIENTS AND METHODS: In the last 10 years (1985 to 1995), we performed 1,267 carotid endarterectomies, with 17 strokes (1.3%) and 16 deaths (1.2%). Twenty-four patients developed acute (within 72 hours) postoperative neurologic deficits. In 10 patients, the carotid artery was confirmed patent by duplex scan or angiography, and the neurologic deficit resolved without further therapy. Early reexploration was performed in 14 cases for suspected thrombosis associated with a new neurologic deficit. In each case, resection of the endarterectomy site and an interposition bypass was performed with greater saphenous vein (11), jugular vein (2), or polytetrafluoroethylene (2) grafts. (One patient required a new bypass for acute occlusion of the initial vein bypass.) Postoperatively, 8 patients had complete resolution of their deficit, 3 had minimal residual deficits, and 3 suffered permanent stroke. However, 2 of these patients died. RESULTS: Carotid artery bypass with exclusion of the endarterectomy site resulted in improvement in symptoms in 79% (11 of 14) of the patients and complete resolution in 57% (8 of 14). In long-term follow up (1 to 41 months), there have been no occlusions and one restenosis requiring revision at 11 months. CONCLUSIONS: Carotid artery bypass can be performed safely with acceptable results. The use of autogenous venous conduits allows reconstruction with an endothelial lined conduit that may improve results in patients with acute postoperative neurologic deficit secondary to thrombosis of the endarterectomized carotid artery.

Acute Disease↗
PubMed1996

Eversion endarterectomy of the internal carotid artery: technique and results in 449 procedures.

BACKGROUND: Preservation of neurological function with a low incidence of restenosis is a measure of the long-term durability of carotid endarterectomy. Routine and selective patch angioplasty of the internal carotid artery have both been used to reduce the incidence of restenosis. The European literature has had many reports of lower restenosis rates in patients undergoing eversion carotid endarterectomy. We evaluated our experience with the eversion carotid endarterectomy procedure over a 2-year period to identify any advantage of this technique. METHODS: Between August 1993 and August 1995, 376 patients underwent 449 carotid endarterectomies (CEAs) using the eversion technique (described below). During the same period, 307 patients underwent 353 CEAs by standard endarterectomy. Demographics were similar in both groups. Fifty-two patients in the eversion group underwent combined open cardiac procedures and carotid endarterectomy. There were 47 such patients in the standard group. Duplex examination was performed after surgery at regular intervals to identify any recurrent stenosis. RESULTS: Operative mortality was 4 of 376 (1.1%) and 6 of 307 (2%) in the eversion and standard groups, respectively. Shunts were used in 15 of 449 patients in the eversion group and 24 of 353 patients in the standard group. Cervical block anesthesia was used in 669 of 687 (97%) of patients undergoing CEA without coronary artery bypass grafting (CABG). There were four permanent neurologic deficits in the eversion group and seven in the standard group, for respective stroke rates of 0.9% and 2%, and there were three transient neurologic deficits in the eversion group and nine in the standard group. There was one (0.2%) restenosis in the eversion group; there were four (1.1%) in the standard group by follow-up duplex scan. CONCLUSIONS: These data demonstrate that eversion carotid endarterectomy can be performed with low stroke and mortality rates in the treatment of extracranial carotid occlusive disease. The incidence of restenosis was lower and approached significance in eversion endarterectomy when compared to standard carotid endarterectomy in the short-term follow-up in this series.

Aged↗
PubMed1996

Fate of the excluded abdominal aortic aneurysm sac: long-term follow-up of 831 patients.

PURPOSE: Nonresective treatment of the infrarenal abdominal aortic aneurysm by proximal and distal ligation of the aneurysm sac (exclusion) combined with aortic bypass has been previously reported. A 10-year experience with 831 patients undergoing this procedure was reviewed. METHODS: From 1984 to 1994, 831 (761 elective, 70 urgent) of 1103 patients being treated for abdominal aortic aneurysm underwent repair with the retroperitoneal exclusion technique. Perioperative morbidity and mortality, estimated blood loss, transfusion requirements, natural history of the excluded aneurysm sac, and long-term survival were all assessed. RESULTS: The operative mortality rate for patients undergoing exclusion and bypass was 3.4%. The incidence of nonfatal perioperative complications was 5.2%. Colon ischemia requiring resection occurred in 2 (0.2%) of the 831 patients. Estimated blood loss was 638 +/- 557 cc (50 to 330 cc). On follow-up 17 (2%) patients were found to have patent aneurysm sacs as detected by duplex examination. Fourteen patients required surgical intervention. No cases of graft infection or aortoenteric fistula have been noted. CONCLUSION: Retroperitoneal exclusion and bypass is a viable alternative to traditional open endoaneurysmorraphy in surgery for abdominal aortic aneurysm. Most excluded aneurysm sacs have thrombosis without any long- or short-term complications; however, in a small number of patients delayed rupture of patent aneurysm occurs, thus emphasizing the need for diligent follow-up and appropriate intervention.

Adult↗
PubMed1996

Results of 1000 consecutive elective abdominal aortic aneurysm repairs.

In order to identify major risks for death and complications from elective repair of abdominal aortic aneurysm, the authors analyzed their experience with the last 1000 such repairs over a 15-year period. Of the patients, 772 were men and 228 were women; average age was 70 (range 37-92) years. Some 20% of the patients had severe chronic obstructive pulmonary disease and 33% had baseline creatinine level > 115 mumol/l. Fifteen patients were dialysis-dependent and 24% (242/1000) had significant cardiac disease. Operation used a retroperitoneal approach in 834 patients and a transperitoneal approach in 166. The perioperative mortality rate was 2.4%, but this did not change either chronologically or with technique: some 50% of the deaths were due to cardiac causes. Renal and pulmonary impairment did not affect mortality or complication; 64% of non-fatal complications were distributed in the renal (17%), pulmonary (19%) and cardiac groups (28%). The authors' experience showed that patients with cardiac disease remain at significant risk for post-abdominal aortic aneurysm repair complications in spite of selective preoperative cardiac evaluation. Renal and pulmonary risk factors did not cause additional mortality or morbidity. They suggest that elective abdominal aortic aneurysm repair can be performed with low mortality and morbidity, even in increasing numbers of high-risk patients.

Adult↗
PubMed1996

Bilateral carotid endarterectomy during the same hospital admission.

The efficacy of carotid endarterectomy for the prevention of strokes has been well demonstrated in recent multicenter randomized trials. However, patients presenting with bilateral significant disease pose a difficult problem to the vascular surgeon. Currently, bilateral carotid endarterectomies are staged at varying intervals between operations, with surgeon and patient weighing the risks of waiting for surgery versus the risks of having both procedures done within a shortened interval. There are few data and no consensus on the optimal time interval between these operations. In order to evaluate the timing of carotid endarterectomies in patients with severe bilateral disease, the authors reviewed their experience with patients who had bilateral procedures performed during one hospitalization. Over the past 5 years, they have performed 204 such carotid endarterectomies in 102 patients. Cervical block anesthesia was used in 99% (201/204) of these procedures. All patients either had symptomatic disease, > 60% stenosis or severe ulcerative plaque as defined by duplex scan and/or preoperative angiography. Symptomatic stenoses were the operative indications in 39% (80/204) of the patients; the remaining 61% (124/204) were symptom-free. The majority of patients (80%; 164/204) had their second procedure performed within 2 days of their first operation. There was no operative mortality and only one permanent neurologic defect in this group for a combined stroke mortality rate of 1%. Three patients (1.5%) had transient neurologic deficits postoperatively which completely resolved by discharge. These data show that bilateral carotid endarterectomies can be performed safely and effectively during one hospital admission with a short interprocedural interval and without an increase in mortality or morbidity.

Aged↗
PubMed1996

Access to the right renal artery from the left retroperitoneal approach.

One of the perceived limitations of the left retroperitoneal approach to the aorta is inadequate access to the right renal artery. Many consider the need for a concomitant right renal artery revascularization a contraindication to performing an aortic reconstruction through the left retroperitoneum. Exposure of the right renal artery can be difficult due to the posterior course of the artery behind the vena cava. However, when the aorta is transected, the right renal artery can be easily approached with anterior and cephalad displacement of the aortic root. Over the past 3 years, 52 patients have had right or bilateral renal artery revascularization via the left retroperitoneal approach; of these procedures, 37 were performed with concomitant aortic procedures. In total, 34 patients had bilateral and 18 had unilateral revascularizations. Five patients had a transaortic endarterectomy performed, and 36 were bypassed with 6-mm expanded polytetrafluoroethylene side limbs from the aortic graft. Indications for revascularization were: 39 for suprarenal aortic bypass, seven for renal salvage and six for primary renovascular hypertension. All reconstructions have remained patent and all have been followed by serial duplex and renal flow scans (follow-up for 1-42 months). The operative mortality rate was 5.8% (3/52). There were no major cardiorespiratory complications in this group. Adequate exposure to the proximal right renal artery can be obtained through the left retroperitoneal approach to the aorta, and successful revascularization of one of both renal arteries can be technically performed with acceptable mortality and morbidity.

Adolescent↗