Surgical Treatment of Renovascular Hypertension

During the last twelve years, twelve patients with renovascullar hypertension, ｆｉｖｅ males and seven females, were treated surgically for this condition. Their ages ranged from fifteen to fifty-one (thirty-one average). Causative diseases were aortitis in four of the patients, atherosclerosis in three, fibromuscular displasia in two. In three of the patients the cause was unknown. Two patients with aortitis in both renal arterial roots which had caused narrowing of the aorta underwent aorto-aortal and aorto-renal bypasses with Decron grafts. One patient improved markedlyl but the other patient's condition was so serve that an end-to-end anastomosis between the splenic and left renal arteries was subsequently performed with considerable improvement. In a patient with stenosis of the left renal artery caused by aorititis, aorto-renal bypass with a Dacron graft was performed without success. Nephrectomy is scheduled because of irreversible renal damage. A patient with stenosis of both renal arteries due to atherosclerosis who had undergone an end-to-end anastomosis between the splenic and left renal arteries and right nephrectomy died of acute renal failure 13 days after surgery. Another patient with stenosis of the right renal artery of unknown origin who had undergone aorto-renal bypass with a Dacron graft, died of cereral bleeding 4 days after surgery. In seven patients, good results followed nephrectomics. However, it is our opinion that renovascular reconstruction should be undertaken first because it is impossible to know pre-operatively whether or not renal damage can be reserved by vascular surgery. If this more conservative surgery is not benefical, it can be followed by nephrectomy.