Renovascular hypertension secondary to arterial fibrodysplasia in adults: criteria for operation and results of surgical therapy.

One hundred thirteen patients (106 women, seven men), 18 to 64 years in age, with hypertension as a consequence of renal artery fibrodysplasia underwent operation during a 13-year period. Renal-systemic renin indexes confirming ischemic kidney hypersecretion with contralateral suppression, and demonstration of collateral vessels circumventing hemodynamically significant stenoses proved reliable predictive indicators of surgical curability. One hundred fifty-eight surgical procedures were performed, including bilateral operations in 18 patients. Most common of 129 primary operations were 98 autogenous saphenous vein aortorenal grafts. Initial nephrectomy was undertaken on three occasions. Ninety-five percent of patients benefited from operation. Sixty-two patients were cured of hypertension; 45 were noticeably improved; and six were surgical failures. No operative deaths occurred. Proper patient selection is the most important determinant of operative curability in patients with renovascular hypertension.