[Surgical treatment of renovascular hypertension: results of operation in 400 patients with renal artery stenosis (author's transl)].

A report is given on patients treated surgically for renal artery stenosis (RAS) and renovascular hypertension. High-quality arteriograms, as well as renal vein (RVR) determination and split-function studies (SFS) are the most important preoperative diagnostic procedures. Since only 40% of the patients with renal artery stenosis have renovascular hypertension, the value of RVR and SFS for diagnosis, indication and prognosis in surgical cases is stressed. Unilateral RAS patients show a 50% cure rate with regard to arteriosclerosis (AS) and 74% in fibromuscular displasia (FD). Improvement following surgery was recorded in 92% and 96% of cases, respectively. Bilateral reconstructions are preferably done as staged procedures. Simultaneous repair results in a higher postoperative thrombosis rate, as well as being a significant risk to both kidneys; only 50% of patients really do need surgical treatment of the contralateral kidney. Patients older than 50 years became normotensive in 36% of cases, 86% showed improvement and 13% no benefit from operation; the mortality rate was 1.3% in patients over 50. Cases with a severe reduction in kidney function (less than 30 ml/min/kidney creatinine clearance) showed a significant increase in creatinine clearance with a 90% improvement in and 36% cure of hypertension, after reconstruction. 50% of totally occluded renal arteries could be revascularized via an appropriate distal vessel; the cure rate in this group was 55%. A higher incidence of renovascular hypertension is seen in patients under the age of 20. 68% of this group became normotensive, whilst only 8% did not show any benefit from surgery. Combined diagnostic procedures to evaluate morphology and functional status of the kidney, as well as the indications for and prognosis of surgery are emphasized; a more refined technical approach to RAS revascularisation is described.