Results of a ten year period of reconstructive surgery for renovascular disease.

During a 10-year period 242 patients underwent 259 renal artery reconstruction for correction of renovascular hypertension or preservation of renal function. Bilateral stenosis was found in 26 patients (10.7%). Twenty-five of the 259 renal arteries were totally occluded. Stenosis was atheroslcerotic in 147 patients, fibrodysplastic in 88 and of other origin in 7 patients. The operative procedures included thrombendarterectomy with or without patch plasty in 105 patients, resection and end-to-end-anastomosis in 68, reimplantation in 34, vein graft interposition in 32, and patch graft angioplasty in 14 patients.--Overall hospital mortality was 4.1%. Whereas there were no deaths in fibrodysplastic disease, it was 6.8% in atherosclerosis. The late mortality of 185 patients followed was 9.2%, stroke and myocardial infarction being the most common causes of death. Postoperatively, blood pressure was normal in 36% of patients with atherosclerosis and in 70% of those with fibrodysplastic disease. Blood pressure improved in 53% of the patients with fibrodysplastic disease. These relationships did not change significantly 2, 4, and 6 years after reconstruction. The results indicate the favorable prognosis of renal artery reconstruction in fibrodysplastic stenosis and the limitations of surgery in atherosclerosis in a non-selected group of patients. Although the introduction of percutaneous intraluminal dilatation widens the therapeutic possibilities for renovascular hypertension, exact indications and intensive after-care are still mandatory.