A RECENT INSTITUTIONAL EXPERIENCE WITH RENOVASCULAR HYPERTENSION

During an 8-year period, 51 patients with renovascular hypertension we re evaluated. Etiologies of renovascular disease included atherosclero sis 29 (57%), Takayasu's arteritis 11 (22%), fibromuscular dysplasia s ix (11%), renal artery dissection two (4%), trauma two (4%), and aneur ysm one (2%). Fifteen (29%) patients had bilateral renal artery diseas e, and 16 (31%) had associated chronic renal failure. Seven patients i nitially underwent percutaneous transluminal angioplasty, three of who m later required operative intervention for recurrent hypertension, an d one required repeat angioplasty. Three patients had no further inter vention. Forty-seven patients underwent surgical revascularization tai lored to the angiographic and intraoperative findings. Procedures perf ormed included 36 (55%) aortorenal bypasses; 12 (18%) endarterectomies ; five (8%) ex-vivo reconstructions; three (4%) renal artery reimplant ations; two (3%) other visceral artery-to-renal (hepatic/splenic) reco nstructions; one (2%) renal artery patch graft; and seven (10%) nephre ctomies. Concomitant aortic replacement occurred in 20 (43%) cases. Th ere were two deaths, and remedial operations for recurrent hypertensio n were required in three patients. The mean follow up was 12 months (r ange 6-45 months). Hypertension was cured in 25 (57%), improved in 14 (32%), and unchanged in five (11%). Of the 16 patients with chronic re nal failure, eight (50%) had a reduction in serum creatinine >10%. The etiology of renovascular hypertension: is variable. Although translum inal angioplasty may be indicated in selected patients, surgical revas cularization is usually necessary. A flexible operative approach to ac commodate the variable patterns df renal artery disease optimizes surg ical results. Renal revascularization may provide an improvement in ex cretory renal function.