Isolated renal artery and combined aortic and renal artery reconstruction for renovascular hypertension. Late results of surgical treatment.

Fifty consecutive patients with renal artery occlusive disease underwent surgery for renovascular hypertension. The etiology was arteriosclerosis; only three patients had fibromuscular hyperplasia. Isolated renal artery stenosis was operated on in 22 patients while 28 patients underwent combined renal and aortoiliac/femoral procedures. Four of the patients required re-operation because of unsuccessful primary results. There was no operative mortality. Renin was determined in 29 patients and postoperative angiography was carried out in 22 cases. The patency rate of the aorto-renal grafts was 94%; 2 aneurysmal vein graft dilatations occurred. Preoperative renin assays were positive in 90% of the patients with isolated renal artery stenosis but in only 45% of those having renal and aortoiliac/femoral arteriosclerosis. Postoperatively, the renin values had returned to normal limits in 95% of the patients. Long-term (2-11 years) successful treatment of hypertension was achieved in 79% of the cases with isolated stenosis and in 59% of the cases with aorto-iliac/femoral arteriosclerosis. The patients having a preoperative ipsilateral/contralateral renin ratio greater than or equal to 1.5 showed a success rate of 69%. Normal levels of renin were found in 85% of the successful cases.