Annals of surgery
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While Type III dissecting aneurysms of the aorta in patients with renal transplants have been described, this report appears to represent the first successful replacement of the ascending aorta with correction of valvar aortic insufficiency in a patient with a Type I aortic dissection. The operative result and subsequent clinical course have been gratifying. On the basis of these findings an aggressive surgical approach is recommended for patients with this combination of conditions.
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Renal artery dissections are stenotic or occlusive lesions most often observed in hypertensive patients with underlying atherosclerosis or fibromuscular disease. Acute dissections may present spontaneously, as a complication of diagnostic or therapeutic angiography or as an agonal event associated with overwhelming systemic illness. Chronic dissections may produce renovascular hypertension or be entirely asymptomatic. ⋯ In addition, renal failure was associated with 59% of the deaths. The lethality of renal artery dissections and the ease and success of revascularization, which preserves renal function and ameliorates associated renovascular hypertension, emphasize the need for an aggressive approach to the recognition and treatment of this entity. Therapy should be directed toward arterial reconstructions and the preservation of functioning renal tissue.