Stefanini P, Benedetti-Valentini F, Fiorani P
Int Surg. 1978 May-Jun;63(4):73-81.
From 1960 to December 1977, 251 patients with renovascular hypertension (RVH) were observed; 219 were operated upon. Long-term results were assessed in 130 patients. Selection for surgery follows three steps: 1) screening of patients with renal artery disease, which is done by angiography; 2) diagnosis of RVH, which is reached mainly by differential renal function studies and renal vein renin measurements (ancillary methods are intravenous pyelography and sequential scintigraphy; the significance of renin measurements is discussed); and 3) prediction of the results of surgery and choice of technique. An original dynamic test of the authors is employed and reconstruction of the renal artery is the procedure of choice. This is done in the majority of cases by aortorenal bypass grafts using dacron prostheses. Techniques and complications are discussed and comparison with venous autograft is made. Hospital mortality was 3.2%. Overall long-term results were favorable in 78%. Long-term mortality was 6% and occurred mainly in patients who remained hypertensive. Results in atherosclerotic patients are compared with those obtained in fibrous stenoses. Results of renal artery reconstructions were far better than those of nephrectomies and lead us to restrict indications for such a procedure.
1960年至1977年12月期间，对251例肾血管性高血压（RVH）患者进行了观察；其中219例接受了手术。对130例患者的长期结果进行了评估。手术选择遵循三个步骤：1）通过血管造影筛选肾动脉疾病患者；2）诊断RVH，主要通过肾功 能差异研究和肾静脉肾素测量来实现（辅助方法是静脉肾盂造影和序贯闪烁扫描；讨论了肾素测量的意义）；3）预测手术结果并选择手术技术。采用了作者原创的动态试验，肾动脉重建是首选手术方式。大多数情况下通过使用涤纶假体的主动脉 - 肾动脉搭桥术来完成。讨论了技术和并发症，并与静脉自体移植进行了比较。医院死亡率为3.2%。总体长期结果良好的占78%。长期死亡率为6%，主要发生在仍有高血压的患者中。将动脉粥样硬化患者的结果与纤维性狭窄患者的结果进行了比较。肾动脉重建的结果远优于肾切除术，这使我们限制了该手术的适应症。
