Surgical treatment of renovascular hypertension. Long-term follow-up of 216 patients up to 20 years.

During a period of 20 years, 216 patients between the ages of 19 and 76 years underwent renal artery reconstruction for correction of renovascular hypertension. Reconstruction was bilateral in 18% of the patients. A transperitoneal approach was used in all cases. The most commonly used reconstructions were aortoneal bypass in 43% of the patients, thromboendarterectomy with primary closure or patch in 26%, and nephrectomy in 11%. There were 13 late nephrectomies. There was no operative mortality. Postoperatively, blood pressure was normal in 85% of the patients, improved in 11% and unchanged in 2%. Follow-up was one to 20 years. Actuarial survival at five years was 93%, at ten years 80%, and at 20 years 70%. Normal blood pressure was present at five years in 81% of the survivors, at ten years in 77%, and at 15 years in 74%. The results indicate the excellent long-term results of renovascular reconstruction for renovascular hypertension in appropriate patients.