Improved results with surgical treatment of renovascular hypertension: an individualized approach.
During a one-year period, 20 patients were treated for renal artery occlusive lesions causing renovascular hypertension. Diagnosis depended on angiography, isotopic renography, and selective renal vein renin determinations in certain patients. Treatment included saphenous aortorenal bypass, 9 patients; endarterectomy, 3 patients; percutaneous angioplasty, 5 patients; and nephrectomy in 3 patients. There was no operative mortality. Eighty-five percent of the patients were improved or cured of hypertension, and the average number of antihypertensive medications required decreased from 3.1 to 1.6. The mean serum creatinine of all patients decreased from 3.6 mg/dl to 2.2 mg/dl. In one subset of patients expanding suprarenal aneurysms caused renal artery stenosis or occlusion. Aortic replacement with renal artery endarterectomy or bypass is the only treatment option for these patients. High risk patients with normal renal function and a glomerular filtration rate less than 15% in the affected kidney can be treated with nephrectomy. Our results demonstrate that an individualized approach to therapy and attention to operative detail is mandatory for successful treatment of renovascular hypertension.
Bartlett
S T
ST
Department of Surgery, University of California, Davis.
Dugoni
W E
WE
Ward
R E
RE
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D000800:Angioplasty, Balloon; D001012:Aorta, Abdominal / Q000601:surgery; D004691:Endarterectomy; D006801:Humans; D006978:Hypertension, Renovascular / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D009392:Nephrectomy; D011183:Postoperative Complications / Q000453:epidemiology; D012074:Remission Induction; D012077:Renal Artery / Q000601:surgery