Surgical treatment of renovascular hypertension
J. C. Stanley and W. J. Fry
Two hundred sixty-four patients exhibiting renal artery occlusive disease
underwent operation for renovascular hypertension between 1961 and 1977.
Included were 27 pediatric patients. Fibrodysplastic disease affected 132
adults. Atherosclerotic lesions affected 51 patients with and 54 patients
without clinically overt extrarenal arteriosclerotic cardiovascular
disease. Ischemic kidney renin hypersecretion (renal: systemic index
greater than 0.48), associated with suppressed contralateral kidney renin
secretion (renal: systemic index approaching 0.0) predicted curability most
reliably. Three hundred forty-eight operations were performed, of which 297
were primary and 51 were secondary procedures. Nephrectomy was initial
therapy in 15 cases. Three operative deaths occurred among 51 patients
manifesting overt extrarenal arteriosclerotic disease. No operative
mortality was encountered among the other 213 patients. Surgical benefits
were afforded 96% of pediatric patients and adults with fibrodysplastic
disease, 91% of patients with focal renal arteriosclerosis, and 73% of
those exhibiting overt extrarenal arteriosclerosis.
