Renovascular hypertension.

In summary, renovascular surgery has evolved during the past 20 years to become a highly efficacious therapeutic modality provided proper patient selection is practiced. Surgical techniques are now well established, and with the advent of ex vivo techniques practically any extraparenchymal renal artery lesion may be repaired. At present, much investigative work is in progress in an attempt to develop better means of selecting patients who will benefit from renovascular surgery. The newer modifications of renal vein renin assays may permit better patient selection. Many factors must be weighted when considering medical versus surgical management of hypertension. Paramount among these must be the quality of life of the patient. The inconstancy of pressure control and the frequency of undesirable side effects in the more extreme medical regimens are the primary disadvantages of nonsurgial management. An aggressive surgical approach appears to be warranted in selected patients with atherosclerosis and in almost all patients with fibromuscular dysplasia.