KIDNEY AUTOTRANSPLANTATION IN PATIENTS WITH RENAL ARTERY PATHOLOGY

We have experience of 11 kidney autotransplantations in patients with various vascular pathologies (9 cases - renal artery stenosis caused by atherosclerosis, fibromuscular dysplasia and nonspecific Takayasu aortoarteriitis), 7 of which came back after previously performed stenting of the renal artery, 1 case - stenosis of the right renal artery with a poststenotic aneurysm). All patients suffered from renovascular hypertension. In all patients, the hypertension crisis exceeded the mark of 200/100 mmHg, with normal blood supply to the contralateral kidney. With long-term arterial hypertension, there is a high risk of developing hypertensive nephroangiosclerosis, with the level of systolic blood pressure (BP) playing a decisive role. Hypertensive nephroangiosclerosis often manifests itself later than damage to other target organs. Kidney pathology may remain unrecognized for a long time, however, with ineffective blood pressure control, manifestations of chronic heart failure increase and cardiovascular complications develop, often with fatal outcomes. Kidney autotransplantation with renal artery reconstruction has advantages when reconstructing the RA with an autovenous vein, in most cases there is an aneurysmal expansion of the autovenous vein. Kidney autotransplantation with renal artery reconstruction has advantages when using a synthetic linear prosthesis, due to neointimal hyperplasia at the anastomotic site, stenosis of the anastomotic orifice is possible. Reconstructions of the right renal artery are considered by technical difficulty due to the anatomical location of the aorta and inferior vena cava.