Renovascular hypertension in the patient with severe atherosclerosis
R. E. Fry and W. J. Fry
From 1976 to 1981, 22 patients were treated for atherosclerotic
renovascular disease and with widespread atherosclerosis. The average age
was 56 years. Preoperatively, the average blood pressure (BP) was 211/123
mm Hg. The standard operation was aortorenal bypass, associated with
resection of an abdominal aortic aneurysm in three cases. Four patients had
nephrectomy. Most patients were referred after failure of a previous renal
revascularization procedure. In three patients, most of the renal arterial
system was thrombotic. All patients had preoperative Swan-Ganz catheter
placement for monitoring of fluid balance, filling pressure, and cardiac
output. Intravenous vasodilators were used to control BP and to reduce the
afterload on the left ventricle. There were no operative deaths. The
average postoperative BP was 136/81 mm Hg. Three patients had improvement
in renal function, and one was able to stop hemodialysis after operation.
Because of a low mortality and overall satisfactory results, patients with
atherosclerotic renovascular hypertension should be considered for vascular
reconstruction.