Radiologic Aspects of Renovascular Hypertension

Abstract

Arteriograms in 2,374 patients in the Cooperative Study of Renovascular Hypertension revealed renovascular disease in 884. The etiology of the renal arterial lesions was atherosclerosis in two thirds and fibromuscular hyperplasia (FH) in one third. A favorable response to surgery was higher in FH than in atherosclerosis. In atherosclerosis where lesions had less than 50% reduction in luminal diameter, favorable response to surgery was 43%, as contrasted with 68% in patients with more than 50% reduction. In FH, 72% of patients with stenosis of less than 50% had a favorable response to surgery. The highest incidence of favorable response (91%) occurred in patients with FH whose stenosis was judged to be greater than 80%. There is no relationship of surgical response to the presence or absence of collateral circulation or poststenotic dilatation. The arteriogram has only limited value in predicting the response to surgery.