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Renovascular Hypertension in the Patient With Severe Atherosclerosis

Renovascular Hypertension in the Patient With Severe Atherosclerosis Abstract • From 1976 to 1981, 22 patients were treated for atheroslcerotic renovascular disease and widespread atherosclerosis. The average age was 56 years. Preoperatively, the average blood pressure (BP) was 211/123 mm Hg. The standard operation was aortorenal bypass, associated with resection of an abdominal aortic aneurysm in three cases. Four patients had nephrectomy. Most patients were referred after failure of a previous renal revascularization procedure. In three patients, most of the renal arterial system was thrombotic. All patients had preoperative Swan-Ganz catheter placement for monitoring of fluid balance, filling pressure, and cardiac output. Intravenous vasodilators were used to control BP and to reduce the afterload on the left ventricle. There were no operative deaths. The average postoperative BP was 136/81 mm Hg. Three patients had improvement in renal function, and one was able to stop hemodialysis after operation. Because of a low mortality and overall satisfactory results, patients with atherosclerotic renovascular hypertension should be considered for vascular reconstruction. (Arch Surg 1982;117:938-941) References 1. Ernst CB, Stanley JC, Marshall FF, et al: Renal revascularization for arteriosclerotic renovascular hypertension: Prognostic implication of focal renal arterial versus overt generalized arteriosclerosis . Surgery 1973; 73:859-867. 2. Foster JH, Dean RH, Pinderton JA, et al: Ten years experience with the surgical management of renovascular hypertension . Ann Surg 1973;177:755-766.Crossref 3. Foster JH, Maxwell MH, Franklin SS, et al: Renovascular occlusive disease: Results of operative treatment . JAMA 1975;231:1043-1048.Crossref 4. Lawrie GM, Morris GC, Soussou ID, et al: Late results of reconstructive surgery for renovascular disease . Ann Surg 1979;191:528-533.Crossref 5. Stanley JC, Fry WJ: Surgical treatment of renovascular hypertension . Arch Surg 1977;112:1291-1297.Crossref 6. Cohn JN, Franciosa JA: Vasodilator therapy of cardiac failure (first of two parts) . N Engl J Med 1977;297:27-32.Crossref 7. Cohn JN, Franciosa JA: Vasodilator therapy of cardiac failure (second of two parts) . N Engl J Med 1977;297:254-258.Crossref 8. Dean MT, Lawson JD, Hollifield JW, et al: Revascularization of the poorly functioning kidney . Surgery 1979;85:44-52. 9. Whitehouse WM, Kazmers A, Zelenock GB, et al: Chronic total renal artery occlusion: Effects of treatment on secondary hypertension and renal function . Surgery 1981;89:753-763. 10. Kuhlmann U, Vetta W, Furner J, et al: Renovascular hypertension: Treatment by percutaneous transmural dilatations . Ann Intern Med 1980; 92:1-6.Crossref 11. Schwarten DR, Yune HY, Klatte EC, et al: Clinical experience with percutaneous transmural angioplasty (PTA) of stenotic renal arteries . Radiology 1980;835:601-604.Crossref 12. Tegtmeyer CJ, Dyer R, Teates CD, et al: Percutaneous transluminal dilatation of the renal arteries: Techniques and results . Radiology 1980; 135:589-599.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Renovascular Hypertension in the Patient With Severe Atherosclerosis

Fry, Richard E.; Fry, William J.
Archives of Surgery , Volume 117 (7) – Jul 1, 1982
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References (13)

Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1982.01380310048011
Publisher site
See Article on Publisher Site

Abstract

Abstract • From 1976 to 1981, 22 patients were treated for atheroslcerotic renovascular disease and widespread atherosclerosis. The average age was 56 years. Preoperatively, the average blood pressure (BP) was 211/123 mm Hg. The standard operation was aortorenal bypass, associated with resection of an abdominal aortic aneurysm in three cases. Four patients had nephrectomy. Most patients were referred after failure of a previous renal revascularization procedure. In three patients, most of the renal arterial system was thrombotic. All patients had preoperative Swan-Ganz catheter placement for monitoring of fluid balance, filling pressure, and cardiac output. Intravenous vasodilators were used to control BP and to reduce the afterload on the left ventricle. There were no operative deaths. The average postoperative BP was 136/81 mm Hg. Three patients had improvement in renal function, and one was able to stop hemodialysis after operation. Because of a low mortality and overall satisfactory results, patients with atherosclerotic renovascular hypertension should be considered for vascular reconstruction. (Arch Surg 1982;117:938-941) References 1. Ernst CB, Stanley JC, Marshall FF, et al: Renal revascularization for arteriosclerotic renovascular hypertension: Prognostic implication of focal renal arterial versus overt generalized arteriosclerosis . Surgery 1973; 73:859-867. 2. Foster JH, Dean RH, Pinderton JA, et al: Ten years experience with the surgical management of renovascular hypertension . Ann Surg 1973;177:755-766.Crossref 3. Foster JH, Maxwell MH, Franklin SS, et al: Renovascular occlusive disease: Results of operative treatment . JAMA 1975;231:1043-1048.Crossref 4. Lawrie GM, Morris GC, Soussou ID, et al: Late results of reconstructive surgery for renovascular disease . Ann Surg 1979;191:528-533.Crossref 5. Stanley JC, Fry WJ: Surgical treatment of renovascular hypertension . Arch Surg 1977;112:1291-1297.Crossref 6. Cohn JN, Franciosa JA: Vasodilator therapy of cardiac failure (first of two parts) . N Engl J Med 1977;297:27-32.Crossref 7. Cohn JN, Franciosa JA: Vasodilator therapy of cardiac failure (second of two parts) . N Engl J Med 1977;297:254-258.Crossref 8. Dean MT, Lawson JD, Hollifield JW, et al: Revascularization of the poorly functioning kidney . Surgery 1979;85:44-52. 9. Whitehouse WM, Kazmers A, Zelenock GB, et al: Chronic total renal artery occlusion: Effects of treatment on secondary hypertension and renal function . Surgery 1981;89:753-763. 10. Kuhlmann U, Vetta W, Furner J, et al: Renovascular hypertension: Treatment by percutaneous transmural dilatations . Ann Intern Med 1980; 92:1-6.Crossref 11. Schwarten DR, Yune HY, Klatte EC, et al: Clinical experience with percutaneous transmural angioplasty (PTA) of stenotic renal arteries . Radiology 1980;835:601-604.Crossref 12. Tegtmeyer CJ, Dyer R, Teates CD, et al: Percutaneous transluminal dilatation of the renal arteries: Techniques and results . Radiology 1980; 135:589-599.Crossref

Journal

Archives of Surgery – American Medical Association

Published: Jul 1, 1982

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