caa a22 4500 477113850 CHVBK 20180405111617.0 cr unu---uuuuu 170330e19960101xx s 000 0 eng 10.1007/BF00451971 doi (NATIONALLICENCE)springer-10.1007/BF00451971 Renovascular hypertension in the elderly: Results of surgical management [Elektronische Daten] [Kimberley Hansen, Marshall Benjamin, Richard Appel, Timothy Craven, Richard Dean] This review summarizes our experience with the operative management of renovascular hypertension (RVH) in elderly patients (≥ 60 years of age). From 7/87 through 6/95,230 of 428 adult patients (54%) undergoing operation of renovascular hypertension at our center were in their seventh (153 patients), eighth (70 patients) or ninth (7 patients) decade of life (mean age: 68 years). There were 117 males and 113 females with blood pressures ranging from 280/190 to 178/90 (mean: 202/102 mmHg). One hundred and eighty patients (78%) had renal insufficiency (i.e., serum creatinine ≥ 1.3 mg/dl). One hundred and four patients (45 %) had severe insufficiency (i.e., serum creatinine ≥2.0 mg/dl), with 23 of these patients being dialysis dependent prior to operation. Two hundred and eighteen (95%) had evidence of organ specific atherosclerotic damage as manifested by cardiac disease (93%), cerebrovascular disease (38%) or renal insufficiency (78%). Operative management consisted of a unilateral procedure in 100 patients, bilateral procedures in 130 patients, including 26 nephrectomies. Simultaneous aortic replacement was performed in 95 patients (41%; 59 AAA and 36 occlusive disease). After surgery, there were 13 operative deaths (6%) and 13 renal artery repairs failed (4%). Hypertension was cured (9%) or improved (77%) in 86% of operative survivors. Renal function was improved in 43% and worsened in 15% of patients with nondialysis dependent renal insufficiency. Eighteen of twenty-three patients (78%) who were dialysis dependent before surgery were removed from dialysis following renal revascularization. On follow-up (mean: 29 months), we found that 28 patients died. Multivariate analysis demonstrated that preoperative congestive heart failure (p = 0.007) and increased serum creatinine (p = 0.001) were significant and independent predictors of death on follow-up. Estimated survival was significantly increased among patients with improved renal function after operation compared with patients unimproved. This review emphasizes the complexity of atherosclerosis in the elderly population presenting for operative management of renovascular hypertension. Despite the complexity of disease, our experience suggests that operative management is beneficial and can be accomplished with acceptable, albeit increased, risk in properly selected elderly patients. For elderly patients with renovascular disease in combination with renal insufficiency (i.e., ischemic nephropathy), improved renal function after operation may convey improved survival. Kluwer Academic Publishers, 1996 renovascular nationallicence hypertension nationallicence elderly nationallicence azotemia nationallicence atherosclerosis nationallicence Hansen Kimberley Department of Surgery, Medicine and Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Medical Center Boulevard, Winston-Salem, North Carolina, USA aut Benjamin Marshall Department of Surgery, Medicine and Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Medical Center Boulevard, Winston-Salem, North Carolina, USA aut Appel Richard Department of Surgery, Medicine and Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Medical Center Boulevard, Winston-Salem, North Carolina, USA aut Craven Timothy Department of Surgery, Medicine and Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Medical Center Boulevard, Winston-Salem, North Carolina, USA aut Dean Richard Department of Surgery, Medicine and Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Medical Center Boulevard, Winston-Salem, North Carolina, USA aut Geriatric Nephrology and Urology Kluwer Academic Publishers 6/1(1996-01-01), 3-11 0924-8455 6:1<3 1996 6 10715 https://doi.org/10.1007/BF00451971 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF00451971 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Hansen Kimberley Department of Surgery, Medicine and Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Medical Center Boulevard, Winston-Salem, North Carolina, USA aut NATIONALLICENCE 700 1- Benjamin Marshall Department of Surgery, Medicine and Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Medical Center Boulevard, Winston-Salem, North Carolina, USA aut NATIONALLICENCE 700 1- Appel Richard Department of Surgery, Medicine and Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Medical Center Boulevard, Winston-Salem, North Carolina, USA aut NATIONALLICENCE 700 1- Craven Timothy Department of Surgery, Medicine and Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Medical Center Boulevard, Winston-Salem, North Carolina, USA aut NATIONALLICENCE 700 1- Dean Richard Department of Surgery, Medicine and Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Medical Center Boulevard, Winston-Salem, North Carolina, USA aut NATIONALLICENCE 773 0- Geriatric Nephrology and Urology Kluwer Academic Publishers 6/1(1996-01-01), 3-11 0924-8455 6:1<3 1996 6 10715 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer