Hybrid laparoscopic technique for renal artery Takayasu arteritis

Abstract

Objective: To evaluate the feasibility of combined laparoscopic technique for different types of vascular reconstruction in the treatment of Takayasu renal artery stenosis.

Design: Retrospective study of seven cases of renal artery stenosis caused by Takayasu arteritis (TA).

Materials: Institutional practice and hospitalised patients. All these patients manifested renal arterial hypertension and failed to percutaneous transluminal angioplasty (PTA) treatment. Different types of revascularisation using hybrid laparoscopic technique were applied.

Methods: Laparoscopic renal artery isolation and kidney mobilisation were first performed. Several types of vascular reconstruction were performed as two patients underwent autotransplantation, four patients aortorenal bypass and one splenorenal bypass. For bypass patients, hypogastric artery was harvested by laparoscopic approach while saphenous vein and spleen artery were dissected by conventional opening. Autotransplantation and arterial anastomosis were then performed through an open incision.

Results: All procedures were performed successfully without major intraoperative complications. The total operative time was 191 (130-280) min while laparoscopic part was 62 (40-105) min. The mean blood loss was 261 (150-400) ml. Postoperative blood pressure returned to normal in five patients but two others required single-agent antihypertensive medication. Minor complications included lumbar artery injury and flank pain each in one case. The anastomosis was patent in all patients and no re-stenosis occurred during 6-40 months of follow-up.

Conclusions: Hybrid laparoscopic techniques involving renal artery dissection and hypogastric artery harvesting are feasible in surgical treatment of Takayasu renal arteritis. This hybrid surgical technique provides an alternative approach to revascularise the renal circulation, especially for the patients of PTA treatment failure.