Macaulay Amechi Chukwukadibia Onuigbo
1* 
, Marie Engesser
1, Sree Susarla
11 Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT. UHC Campus, 1 South Prospect Street, Burlington, VT 05401, USA
Abstract
Following the recent publications of the STAR-study, the ASTRAL trial, the HERCULES trial
and the CORAL trial on renal revascularization versus medical therapy in the management
of atherosclerotic renovascular disease, there has been a near paradigm shift implying the
nonutility of revascularization as a useful and necessary therapeutic option. Our recent
experience with a patient who underwent an anastomotic bypass revascularization for
worsening renal failure and uncontrolled hypertension in bilateral calcific atherosclerotic
renal artery stenosis in Burlington, VT rekindled this debate. We posit that in appropriately
selected patients, patients with acutely worsening renal failure, uncontrolled hypertension
and/or symptomatic pulmonary edema, there is indeed a place for revascularization therapy,
especially in the light of improved and safer surgical and anesthesiology techniques. It must be
correctly acknowledged that the above well popularized randomized trials recruited mostly
patients with otherwise stable chronic kidney disease at the time of enrollment. Similarly,
only 12% of the patients in both arms of the ASTRAL trial demonstrated rapidly worsening
renal failure prior to enrollment
Implication for health policy/practice/research/medical education:
There continues an ongoing debate as to the appropriateness and/or utility of mechanical revascularization procedures in the
management of atherosclerotic renovascular disease. In the light of more recent trails including the STAR-study, the ASTRAL
trial, the HERCULES trial and the CORAL trial, the general consensus has gravitated towards the opinion that there is hardly
any indication for such revascularization procedures versus medical therapy alone. Our recent experience with a female patient
with symptomatic and progressive atherosclerotic renovascular disease who responded promptly to spleno-renal anastomosis
has rekindled this controversy. We posit that in appropriately selected patients with a priori worsening renal failure, uncontrolled
or accelerated hypertension and/or pulmonary edema, there is indeed a place for the mechanical therapeutic restoration of renal
blood flow.
Please cite this paper as: Onuigbo MAC, Engesser M, Susarla S. Spleno-renal anastomotic bypass revascularization for
worsening renal failure and uncontrolled hypertension in bilateral calcific atherosclerotic renal artery stenosis. J Renal Inj Prev.
2019;8(4):253-256. DOI: 10.15171/jrip.2019.48.