Long-term prognosis of surgical treatment of renovascular hypertension: A fifteen-year experience

Abstract

To determine the long-term prognosis for hypertension control, mortality, renal function, and maintenance of renal blood flow in patients operated on to control renovascular hypertension, we studied 60 patients managed surgically between 1969 and 1984. Thirty-six patients had atherosclerotic disease, 22 had fibromuscular dysplasia, one had neurofibromatosis, and one had a combination of atherosclerosis and pyelonephritis. We confined the analysis to the 58 patients with pure atherosclerosis or fibromuscular dysplasia. In the atherosclerosis group 14 patients died and the results of hypertension control in the remaining 22 were classified as (1) cured, three (14%); (2) improved, 15 (68%); (3) failed, one (5%); and (4) unknown, three (14%). In the fibromuscular dysplasia group one patient died and results of hypertension control in the remaining 21 patients were (1) cured, 10 (48%); (2) improved, 10 (48%); and (3) failed, one (5%). The 5- and 10- year survival rates were 79% and 40%, respectively, for the atherosclerosis group and 95% and 89%, respectively, for the fibromuscular dysplasia group. Renal function was well maintained for patients in both groups. The mean serum creatinine value was 1.4 mg/dl in the atherosclerosis group and 1.0 mg/dl in the fibromuscular dysplasia group. To evaluate the effect of operation on the maintenance of renal blood flow we compared the blood flow of the operated and unoperated sides in patients who had a unilateral operation and had a second kidney for comparison. Eight of these patients had scans in each of the two groups. The mean renal blood flows on operated and unoperated sides were 151.5 ml/min and 166.8 ml/min (no statistical significance, n.s.s.) in the atherosclerosis group and 173.6 ml/min and 217.9 ml/min (n.s.s.) in the fibromuscular dysplasia group. Since the reason for not operating on the second side was the absence of a significant stenosis, these results suggest that operation on a stenosed renal artery restores the long-term prognosis for preservation of renal blood flow to that expected in the absence of significant stenosis.