Chronic total renal artery occlusion: effects of treatment on secondary hypertension and renal function

Chronic total occlusion of 42 main renal arteries was documented by arteriographic studies in 25 female and 15 male patients being evaluated for drug-resistant hypertension. Arteriosclerotic lesions affected 35 patients, and fibrodysplastic obstructions occurred in five. Hypertensive urographic studies showed lateralization to the affected kidney in all 31 studies obtained. Renal vein renin activity lateralized with a mean ratio of 3.88 in the 24 patients studied. In 15 patients, mean renal: systemic renin indices (RSRI) of 2.39 confirmed ischemic kidney renin hypersecretion, and a mean RSRI of 0.03 confirmed contralateral suppressed secretion. Affected kidney lengths averaging 9.4 cm were significantly smaller than the 13.0 cm length of kidneys without occluded arteries. Thirty patients with 31 occluded arteries underwent renal artery bypass (18), endarterectomy (2), or nephrectomy (11). There were two perioperative deaths. Eighty-nine percent of survivors benefited in regard to hypertension control, and 47% exhibited improved renal function. Nonoperative treatment of 10 patients was associated with frequent progression of renal failure and inadequate blood pressure control. This experience documents the appropriateness of surgical therapy for secondary hypertension caused by chronically occluded renal arteries.