[Late renal revascularization]

Late renal revascularization could be indicated in totally occluded renal artery with hypertension and or renal insufficiency. Six cases of secondary revascularization after occlusion of renal artery are reported here. In three cases severe renovascular hypertension was the indication for renal revascularization. In three other cases, indication was proposed for renal insufficiency. In four cases, renal revascularization for totally occluded renal artery have been beneficial for the patients. In two cases of terminal renal insufficiency, chronical hemodialysis could be suppressed. In the others two cases, hypertension was clearly improved. The criteria for renal revascularization before and during surgery are discussed here. The kidney length, the cortico-medullary ratio at kidney echography, and the visualization of a nephrography during angiography are the principal criteria before surgery for renal revascularization. The macroscopic aspect of the kidney, the immediate results of renal biopsy and the importance of a blood reflow in the renal artery are the principal criteria during surgery, but must be discussed because there are no definitive criteria. Renal revascularization shall be proposed when totally occluded renal artery is associated with renal insufficiency and/or hypertension, especially when the other side can be affected by the same disease.