Experience with 200 Renal Artery Reconstructive Procedures for Hypertension or Renal Failure

Abstract

Renovascular hypertension is the most common form of reversible hypertension. An analysis of 200 renal artery reconstructive procedures identified atherosclerosis as the arteriopathic lesion in 83 per cent of cases and fibromuscular hyperplasia in 13 per cent of cases. Bilateral renovascular disease was found in 31 per cent of cases. Renal arteriography is the most significant factor in the diagnostic evaluation of the hypertensive subject. Bypass graft and patch-graft angioplasty were the most commonly employed principles of renal artery reconstruction in this series. The occlusive process in the renal artery produced a pressure gradient exceeding 25 mm. Hg in 76 per cent of cases. The average period of observation following operation in these 200 patients was 1.6 years, ranging between 3 months and 5 years. Eighty per cent of patients are now normotensive. The primary goal of operation in 12 patients was reversal of renal failure due to severe bilateral renal artery occlusive disease. Disappearance of azotemia with improved renal function followed revascularization in 11 of 12 patients.