Operative management of renovascular hypertension.
From 1966 to 1975, 38 patients underwent 42 procedures for renovascular hypertension; 35 operations were aortorenal bypasses and 7 were nephrectomies. Forty-five per cent of the patients were cured, 43% were improved and 12% were unimproved. There were no operative deaths and only three late deaths. Two grafts occluded and 2 became stenotic, giving a graft complication rate of 12%. Curability was best correlated with a short history of hypertension and a pathologic diagnosis of fibromuscular hyperplasia, but not with patient age. Most patients selected for surgery had elevated renal venous renin ratios, and of these 95% were cured or improved. Of those with normal renin ratios, 85% were still cured or improved. Postoperative aortography and peripheral renin measurements offered valuable information in predicting the ultimate response to surgery. Preservation of renal function was a principal indication for surgery in 11 patients. In 8, azotemia was documented preoperatively. Hypertension was cured or improved in every case and 5 patients demonstrated a 10-50% reduction in BUN and creatinine following revascularization.
D001011:Aorta / Q000601:surgery; D001161:Arteriosclerosis / Q000150:complications; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006977:Hypertension, Renal / Q000097:blood / Q000601:surgery*; D008297:Male; D008722:Methods; D008875:Middle Aged; D009392:Nephrectomy; D012077:Renal Artery / Q000601:surgery; D012078:Renal Artery Obstruction / Q000601:surgery; D012083:Renin / Q000097:blood; D012501:Saphenous Vein / Q000637:transplantation; D013997:Time Factors; D014182:Transplantation, Autologous
D012083:Renin