Further Experiences in the Diagnosis and Treatment of Renovascular Hypertension

The history of operations to correct renal artery stenosis is reviewed and the results of surgical treatment in 125 cases are described. Nephrectomy is indicated for severe degrees of renal atrophy, multiple branch lesions and unsuccessful previous arterioplasty. The results of partial nephrectomy for branch disease are generally poor. Endarterectomy is indicated for well defined atherosclerotic plaques and resection and reanastomosis is useful for discrete and short stenosing lesions but bypass grafts are the most popular and useful reconstructive operations. Generally good results have been obtained with dacron bypass grafts but long term evaluation is needed to determine late patency. The sþlenorenal bypass is an excellent choice for lesions of the left renal artery when the splenic artery is normal. General guides in the performance of operations on the renal vessels are given and the future of renovascular surgery is discussed with reference to possible usefulness of autotransplantation of the kidney and selection of medical vs. surgical therapy for patients with diffuse vascular disease, advanced age and irremediable renovascular lesions.