Abstract
ABSTRACT. There have been many reasons for hesitating when faced with the decision whether or not to operate upon a renal artery stenosis in an aged person. Arteriosclerotic disease carries a poorer prognosis than does fibromuscular dysplasia, and in old persons arteriosclerosis is the usual cause of renal artery stenosis, and is likely to be generalized. In this study of 24 patients above 60 years of age with renovascular disease, 11 were operated upon; 9 because of renovascular hypertension and 2 with the main aim of arresting the deterioration of renal function. The selection of candidates was mainly determined by the renin secretion pattern. After operation for renovascular hypertension, 67% of the patients improved. In these patients renal function remained stable or recovered. Of the two patients operated upon because of decreasing renal function, one died postoperatively and the other suffered from technical complications resulting in a further impairment of renal function without any beneficial effect on the high blood pressure. Of the 13 patients not operated upon, 4 were clearly renin‐positive and would have been candidates for surgery had it not been for complicating factors. Three of these patients died of coronary disease within one year of the investigation. The results of our and other studies, together reviewing the fate of 56 patients above 60 years of age operated upon for renovascular hypertension, do not indicate that old age per se should be considered a contraindication to surgery when proper attention is paid to co‐existing risk factors. The majority of patients operated upon for renovascular hypertension will benefit from the surgical treatment.
Published Version
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