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. 1975 Dec;182(6):762–766. doi: 10.1097/00000658-197512000-00019

Operative management of renovascular hypertension.

P R McCombs, H D Berkowitz, B Roberts
PMCID: PMC1343976  PMID: 1190880

Abstract

From 1966 to 1975, 38 patients underwent 42 procedures for renovascular hypertension; 35 operations were aortorenal bypasses and 7 were nephrectomies. Forty-five per cent of the patients were cured, 43% were improved and 12% were unimproved. There were no operative deaths and only three late deaths. Two grafts occluded and 2 became stenotic, giving a graft complication rate of 12%. Curability was best correlated with a short history of hypertension and a pathologic diagnosis of fibromuscular hyperplasia, but not with patient age. Most patients selected for surgery had elevated renal venous renin ratios, and of these 95% were cured or improved. Of those with normal renin ratios, 85% were still cured or improved. Postoperative aortography and peripheral renin measurements offered valuable information in predicting the ultimate response to surgery. Preservation of renal function was a principal indication for surgery in 11 patients. In 8, azotemia was documented preoperatively. Hypertension was cured or improved in every case and 5 patients demonstrated a 10-50% reduction in BUN and creatinine following revascularization.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bourgoignie J., Kurz S., Catanzaro F. J., Serirat P., Perry H. M., Jr Renal venous renin in hypertension. Am J Med. 1970 Mar;48(3):332–342. doi: 10.1016/0002-9343(70)90064-1. [DOI] [PubMed] [Google Scholar]
  2. Buda J. A., McAllister F. F., Sommers S. C. Surgical treatment of renovascular hypertension. Am J Surg. 1970 May;119(5):574–578. doi: 10.1016/0002-9610(70)90178-9. [DOI] [PubMed] [Google Scholar]
  3. Dean R. H., Burko H., Wilson J. P., Mulherin J. H., Foster J. H. Deceptive patterns of renal artery stenosis. Surgery. 1974 Dec;76(6):872–881. [PubMed] [Google Scholar]
  4. Dean R. H., Foster J. H. Criteria for the diagnosis of renovascular hypertension. Surgery. 1973 Dec;74(6):926–930. [PubMed] [Google Scholar]
  5. Ernst C. B., Bookstein J. J., Montie J., Baumgartel E., Hoobler S. W., Fry W. J. Renal vein renin ratios and collateral vessels in renovascular hypertension. Arch Surg. 1972 Apr;104(4):496–502. doi: 10.1001/archsurg.1972.04180040110019. [DOI] [PubMed] [Google Scholar]
  6. Ernst C. B., Stanley J. C., Marshall F. F., Fry W. J. Autogenous saphenous vein aortorenal grafts. A ten-year experience. Arch Surg. 1972 Dec;105(6):855–864. doi: 10.1001/archsurg.1972.04180120036008. [DOI] [PubMed] [Google Scholar]
  7. Foster J. H., Dean R. H., Pinkerton J. A., Rhamy R. K. Ten years experience with the surgical management of renovascular hypertension. Ann Surg. 1973 Jun;177(6):755–766. doi: 10.1097/00000658-197306000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Fry W. J., Ernst C. B., Stanley J. C., Brink B. Renovascular hypertension in the pediatric patient. Arch Surg. 1973 Nov;107(5):692–698. doi: 10.1001/archsurg.1973.01350230048010. [DOI] [PubMed] [Google Scholar]
  9. Gould A. B., Skeggs L. T., Kahn J. R. Measurement of renin and substrate concentrations in human serum. Lab Invest. 1966 Nov;15(11):1802–1813. [PubMed] [Google Scholar]
  10. Gunnells J. C., Jr, McGuffin W. L., Jr, Johnsrude I., Robinson R. R. Peripheral and renal venous plasma renin activity in hypertension. Ann Intern Med. 1969 Sep;71(3):555–575. doi: 10.7326/0003-4819-71-3-555. [DOI] [PubMed] [Google Scholar]
  11. Kaufman J. J. Long-term results of aortorenal dacron grafts in the treatment of renal artery stenosis. J Urol. 1974 Mar;111(3):298–304. doi: 10.1016/s0022-5347(17)59952-8. [DOI] [PubMed] [Google Scholar]
  12. Michelakis A. M., Foster J. H., Liddle G. W., Rhamy R. K., Kuchel O., Gordon R. D. Measurement of renin in both renal veins. Its use in diagnosis of renovascular hypertension. Arch Intern Med. 1967 Oct;120(4):444–448. [PubMed] [Google Scholar]
  13. Shapiro A. P., Perez-Stable E., Scheib E. T., Bron K., Moutsos S. E., Berg G., Misage J. R. Renal artery stenosis and hypertension. Observations on current status of therapy from a study of 115 patients. Am J Med. 1969 Aug;47(2):175–193. doi: 10.1016/0002-9343(69)90145-4. [DOI] [PubMed] [Google Scholar]
  14. Simon N., Franklin S. S., Bleifer K. H., Maxwell M. H. Clinical characteristics of renovascular hypertension. JAMA. 1972 May 29;220(9):1209–1218. [PubMed] [Google Scholar]
  15. Stanley J. C., Ernst C. B., Fry W. J. Fate of 100 aortorenal vein grafts: characteristics of late graft expansion, aneurysmal dilatation, and stenosis. Surgery. 1973 Dec;74(6):931–944. [PubMed] [Google Scholar]
  16. Vaughan E. D., Jr, Bühler F. R., Laragh J. H., Sealey J. E., Baer L., Bard R. H. Renovascular hypertension: renin measurements to indicate hypersecretion and contralateral suppression, estimate renal plasma flow, and score for surgical curability. Am J Med. 1973 Sep;55(3):402–414. doi: 10.1016/0002-9343(73)90139-3. [DOI] [PubMed] [Google Scholar]

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