Intraoperative Hemodynamics of Renovascular Hypertension

Abstract

DESPITE the improvement in recent years of methods for selection of hypertensive patients for renovascular surgery, and despite the overall favorable results of surgery, there remains an element of uncertainty in the prognosis for the individual patient. Various criteria which indicate a favorable prognosis have been suggested such as the degree of abnormality of split renal function tests, the characteristics of the radioactive renogram, the angiographic appearance of the stenosis or the intrarenal vessels, and recently renal vein renin assay levels. None of these to date are truly reliable indicators of the likely outcome, assuming a good technical result of renovascular reconstruction, and all too often the surgeon must operate and hope for the best. The prognosis for the individual patient hinges on three factors: a surgically accessible renal artery lesion which is hemodynamically significant, its successful correction, and whether the kidney beyond, if it is the source of increased