Bilateral ostial renal arterial stenoses are in fact atheromatous lesi
ons of the aortic wall. These anatomic features must be considered for
the treatment of such lesions. It can be achieved by bilateral renal
bypass grafting with the concomittant replacement of the aorta when ne
cessary. This combined surgery carries a certain operative risk, which
has been notably lowered with the recent advances in anaesthesiology
and intensive care. We consider this combined renal and aortic surgery
is easier and safer than transaortic endarterectomy.