Operative therapy of renovascular hypertension

Abstract

Three hundred and thirteen patients exhibiting renal artery occlusive disease underwent operation for renovascular hypertension. These included 34 paediatric and 144 adult patients with fibrodysplastic disease. Atherosclerotic lesions affected an additional 64 patients without and 71 patients with clinically overt extrarenal arteriosclerotic cardiovascular disease. Ischaemic kidney renin hypersecretion (renal: systemic renin index > 0·48), associated with suppressed contralateral kidney renin secretion (renal: systemic renin index approaching 0·0), predicted curability most reliably. Four hundred and fifteen operations were performed of which 356 were primary and 59 were secondary procedures. Aortorenal bypass using autogenous vein (227 cases) or prosthetic grafts (62 cases) was the most common primary operation. Nephrectomy was the initial therapy in 17 cases. Six operative deaths occurred in patients manifesting overt extrarenal arteriosclerotic disease. No operative mortality was encountered among the remaining 242 patients. Improvement was seen following operation in 97 per cent of paediatric patients and 94 per cent of adults with fibrodysplastic disease, in 91 per cent of patients with focal renal arteriosclerosis and in 72 per cent of those exhibiting overt extrarenal arteriosclerosis.