Renal arterial stenosis and hypertension. II. Current criteria for surgery

Criteria developed from a previously reported study in 1969 concerning outcome of renal arterial surgery were applied over the next 5 years (1967 through 1971) to a group of 33 patients from a total of 121 with renal arterial stenosis. After demonstration of ischemia of the involved kidney, surgery was performed only when the degree of atherosclerotic disease and complications were minimal. With this selective process the incidence rate of significant postoperative improvement was raised from 26 to 75 percent and was maintained at 60 percent through the end of 1973, the mortality rate decreasing from 35 to less than 10 percent. The data indicate that medical therapy is the initial treatment of choice in patients over 50 to 55 years of age who have atherosclerotic disease but that the outcome of surgery can be satisfactory in properly selected younger patients.