1983 Volume 74 Issue 7 Pages 1161-1168
Clinical characteristics of 48 patients with renovascular hypertension in 23 years (1958-1981) were summarized and discussed. Etiological disorders included fibromuscular dysplasia (19 patients), atherosclerosis (13 patients), aortitis syndrome (4 patients), aneurysm of renal artery (4 patients) and unknown (7 patients). Thirty-eight patients (43 kidneys) were surgically treated, mainly by nephrectomy or reconstruction by spleno-renal anastomosis, aorto-renal bypass or vein patch graft in early years, mainly by renal autotransplantation or nephrectomy in recent years.
Short-term cure rate with operative procedures was 71% overall, 90% in recent 10 years. Better results were obtained by renal autotransplantation or nephrectomy rather than reconstructive surgery except autotransplantation. Operative mortality was documented in 2 patients (infection or renal failure).
Hypertension of renovascular origin which had been resistent to medical management has become comparatively easily controlled by renin-angiotensin inhibitors in recent years. However, operative intervention with the purpose of restoring renal blood flow and maintaining renal function should be considered first. Renal revascularizarion must be tried if possible and nephrectomy is indicated only for a nonsalvageable kidney or for a technically nonreconstructable lesion. We have performed renal autotransplantation in 14 patients with good and stable outcome.
