Surgical considerations in the treatment of renovascular hypertension

The most frequent causes of postoperative failure in operations for stenosis of the renal artery are technical errors, that is, incomplete correction of renal inflow or outflow, or both, and incorrect selection of patients with additional damage to the parenchyma of the kidney. Several new principles ensure a high degree of security in the correction of impaired renal blood flow: one field correction; partial ex situ repair; improvement of the renal run-off by mechanical dilatation of the arterial branches, and one session repair of contralateral renal artery or other intraabdominal vascular lesions. Total segmental occlusions of the main artery, with or without impending uremia, should no longer be considered as a routine indication for nephrectomy, particularly when residual renal function and contralateral blood supply to the post-occlusive kidney can be demonstrated. Surgical revascularization may offer remarkably good results and achieve normalization of renovascular hypertension and kidney function.