Surgical treatment of vasorenal hypertension in nonspecific aorto-arteritis (Takayasu's disease).

The authors present a series of 128 patients with vasorenal hypertension secondary to nonspecific aorto-arteritis. Seventy two patients have been operated upon. This is the largest series of patients so far recorded in the literature. In the preliminary diagnosis of VRH nuclide renography plays an important role, as well as intravenous urography and angiography. To define operative indications and choice of operative treatment additional methods are of value: determination of renin activity in the renal veins and nuclide renography under conditions of induced hypotension. Of 72 operated patients only 5 had primary nephrectomy; in 67 patients (90.3%) revascularization of the kidneys was performed, 42 patients had one-stage reconstruction of the aorta or its branches (visceral or renal). For reconstruction of the renal arteries dacron grafts and transaortic endarterectomy have been most often used. Good and excellent results in the immediate postoperative period have been noted in 91.8% of patients and in the late period (at 1-14 years) in 82.3%, this fact points to the efficacy of operative treatment. In recent years (1975-1979) postoperative mortality has been reduced to 3.7% as the result of improved and modified operative technique and proper choice of surgical approach.