series in the literature. Nevertheless, one retrospective study of 222 patients from 1974 to 1987, encompassing a mean follow-up of 7.4 years, showed an operative mortality of 2.2%, hypertension improvement in 72.4% and preservation of renal function in 71.3%.36

29.7  Prognosis

The presence of ARVD is associated with a guarded prognosis. The strong presence of other co-morbid cardiovascular disease is reflected in the high incidence of cardiovascular events37,38 and death. In fact, the risk of death is almost six times greater than that of progressing onto renal replacement therapy (RRT).1 Patients who do require RRT have a poor life expectancy.8,39 However, with improvement in management (e.g., blood pressure control and statin use), the natural tendency of RAS lesions to progress over time is controllable.18 In the ASTRAL study, insights were provided that suggest that cardiovascular risk management is having an effect upon reducing mortality in ARVD. The annual mortality in ASTRAL was around 8% for all patients (mean age 70 years), which is half that of the 16.3% noted in the previous largest epidemiological cohort of ARVD patients (a 5% random sample of the US Medicare population involving patients aged >67 years) who had been studied in 2001–2002.1 About 85% of ASTRAL patients were receiving a statin at 1 year follow-up, and 80% were receiving anti-platelet therapy. The focus of management during follow up of this patient would include lifestyle modification advice, control of blood pressure and monitoring of renal function. [Q5: A]

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