Late results of surgical treatment for renovascular hypertension

Over a 4-year period, 32 patients, 11 females and 21 males between 18 to 62 years of age (mean age 39 years) were operated on because of renovascular hypertension. Three patients were operated on bilaterally. The most common type of arterial reconstruction was aortorenal venous bypass. Early nephrectomy was performed in two patients, and secondary nephrectomy due to graft occlusion in four patients. There was no operative mortality. Seven patients died during follow-up, five of them of cardiovascular causes. The proportion of patients who were cured or improved by surgery throughout a follow-up of two to 72 months (mean 24 months) exceeded 87%. Nine of these 28 patients were normotensive, the other 19 were improved with less need of drugs following surgery. Four patients were failures. Lateralizing renal venous renin activity was found to be the best single criterion for prediction of improvement following surgery. In the majority of the patients who were cured after surgery, there was no preoperative heart hypertrophy and fundoscopic findings were normal or mildly pathological. A higher incidence of hypertensive changes in the target organs was observed preoperatively in the improved patients than in the cured ones.