SURGICAL-TREATMENT OF RENOVASCULAR HYPERTENSION

Treatment of renal artery stenosis has changed over the last few years. Today renovascular hypertension is no longer an indication for primary surgery. This is due to further development of satisfactory drug treatment, progress in transluminal catheter angioplasty and disappointing surgical results (42% nonresponders) in lowering blood pressure. Surgical treatment aims primarily at retaining the kidney. Therefore subtotal unilateral or bilateral stenoses and increasing renal insufficiency are indications for surgery; furthermore, failure of hypertensive drug treatment and unequivocal demonstration of renovascular causes are decisive, in case transluminal catheter angioplasty is impossible. Essential criteria for selection are localisation and kind of stenosis, age of patient, obesity, duration of hypertension and exclusion of renal parenchymal diseases. In 195 patients at our hospital renal artery stenosis was caused in 42% of cases by atherosclerosis, in 34% by fibromuscular dysplasia. Indication for surgery in 152 patients was arterial hypertension, in 21 patients compensated renal failure combined with hypertension. In 3 patients renal failure was the only indication for surgery. In 11 cases prophylactic reconstruction of renal arteries with the necessary aortoiliacal reconstructions was performed. Preferred surgical procedure was aortorenal bypass with artificial blood vessels (Dacron, PTFE) in 46 patients. Postoperative early occlusion occurred in 10%, hospital mortality was 8% [16]. In over 90% organ conservation was possible by revascularisation of renal arteries.