Technique and complications in the surgical treatment of renovascular hypertension

147 operations for renovascular hypertension were performed in 125 patients. 136 of the operations were vascular reconstructions. Aortorenal by-pass, using saphenous vein as a graft, was found to be a satisfactory technique. An aneurysmatic dilatation developed twice, which on both occasions was attributed to a stenosis proximal to the graft. Two failures also occurred among the 12 patients undergoing renal autotransplantation, both due to an illiac vein thrombosis, obstructing the renal vein. The majority of the six deaths were due to myocardial infarctions or uremia. They all occurred in the eldest patients (older than 59 years) and in patients suffering from complicating cardiac or renal disease. The results with regard to blood pressure were very good in fibrous dysplasia and in atherosclerosis affecting only one side. Operative treatment can therefore be recommended to these groups of patients even in relatively mild hypertension. The indication to operate should be restricted in elderly patients suffering from cardiac and renal complicating diseases, and in patients with bilateral atherosclerotic stenosis.