Special technics in renovascular surgery

Apart from the critical selection of patients, surgical results in renovascular surgery depend mainly on technical problems. To overcome most frequent technical handicaps, such as a deep abdominal cavity, intervening structures, additional distal stenoses and limited ischemic tolerance time, several technical principles may be recommended. An anterior transperitoneal approach usually ensures an optimal exposure. The 'one-field repair' and the 'partial ex situ repair', include the advantage of excellent exposure and a superficial operating field. Particularly in cases of renal artery stenosis of the fibromuscular type, the routinely performed distal 'run-off control' by mechanical dilatation of the arterial branches, allows a high degree security. As in other fields of surgery, renovascular interventions should be directed to the principle of technical simplicity. Following this surgical concept there is only limited indication for the use of 'total ex situ repair' with heterotopic kidney replantation. We feel that this major time-consuming procedure has only a very small place in renovascular surgery, but a very real place in the correction of intrarenal lesions.