If only 1 per cent of the 23 million hypertensive patients in the United States had renovascular hypertension, many patients would be denied the chance for cure. Strong clinical suspicion plus arteriography are the mainstays of diagnosis. Positive renal vein renin studies provide the best preoperative evidence for cure by operation, but many patients with negative studies benefit from operation. Surgeons have been ingenious in devising methods of renal revascularization. Those we prefer are listed in Table 12-6. In most cases it should be possible to revascularize the kidney successfully without resorting to nephrectomy. About nine out of ten patients should benefit from operation; of these, some should be cured and others improved even though antihypertensive medication might be required.
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