Occlusive Disease in Renal Arteries

Correlation between preoperative diagnostic tests and relief of hypertension after renal revascularization procedures remains difficult and uncertain.^1,2 A small but significant number of patients do not experience a satisfactory decrease in blood pressure after a technically successful arterial restoration. Predictability of the surgical result based upon renal biopsy material is also unreliable. The result of nephrectomy whether total, partial, or segmental, is equally difficult to predict. Hence resection should not be undertaken unless there is unequivocal evidence of nonfunction of all or part of the suspected kidney. These observations, plus accumulating evidence that normal, functioning renal tissue has an antihypertensive effect, have strengthened our conviction that conservation of renal tissue is as important as adequate arterial reconstruction.^3,4 This opinion is bolstered by the occasional patient in whom improvement in renal function, manifested by relief of azotemia and irrespective of blood pressure response, is obtained after revascularization.⁵

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