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Results of surgical treatment of renovascular hypertension
Insights
Surgical intervention for renovascular hypertension yields high success rates. A vigorous approach to functionally significant renal artery disease offers significant patient benefits and improved outcomes.
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Vascular Surgery
Background:
- Renovascular hypertension is a significant secondary cause of elevated blood pressure.
- Identifying and treating functionally significant renal artery lesions is crucial for patient management.
Purpose of the Study:
- To evaluate the outcomes of surgical intervention in patients with renovascular hypertension.
- To assess the efficacy of a comprehensive protocol for identifying and treating renal artery disease.
Main Methods:
- A cohort of 77 patients with renovascular disease underwent surgical treatment.
- Patients were categorized based on the etiology (atherosclerosis vs. fibrodysplasia) and laterality (unilateral vs. bilateral) of renal arterial lesions.
- Surgical strategies aimed at renal mass preservation were employed, with secondary nephrectomy considered when reconstruction failed.
Main Results:
- An overall cured-improved rate of 90% was observed across the patient population.
- The highest cure rates were noted in unilateral fibrodysplasia, while bilateral atherosclerotic disease had the lowest.
- Vascular reconstruction was attempted in 11 patients, with 5% failure necessitating secondary nephrectomy, which ultimately yielded good results.
Conclusions:
- A proactive surgical strategy for renovascular hypertension is effective when applied to accurately diagnosed, functionally significant renal artery lesions.
- Treatment outcomes vary based on the underlying pathology and extent of the disease.
- Nephrectomy remains a viable option with good outcomes following failed revascularization attempts.
Abstract:
We have used a comprehensive protocol to identify secondary forms of hypertension and operated upon 77 patients with functionally significant renovascular disease. The population included 52 patients with atherosclerotic renal arterial lesions (31 unilateral and 21 bilateral) and 25 patients with fibrodysplasia (19 unilateral and 6 bilateral). In the entire population there was a 90% cured-improved rate, a 5% failure rate and a 5% postoperative mortality. The cure rate was highest in the unilateral fibrodysplasia group and lowest in those with bilateral atherosclerotic disease. The choice of initial operative approach was based on an attempt to preserve renal mass; in 11 patients vascular reconstruction was attempted and these required secondary nephrectomy because of early or late failure. All 11 patients had a good result after nephrectomy. Our observations indicate that a vigorous operative approach to renovascular hypertension is beneficial once accurate demonstration of a functionally significant lesion is made.