Surgical management of renovascular disease.

Primary emphasis in the surgical management of renovascular disease is on preserving functioning renal tissue with nephrectomy as a last resort for a nonsalvageable kidney or a nonreconstructable situation. There are numerous techniques for renal artery revascularization. Most are not applicable to all types of lesions; selection depends on the pathologic and anatomic features of each individual case, the clinical situation, and the preference of the individual surgeon. Aortorenal bypass grafts are most frequently used. Controversy continues regarding the material of choice for the bypass graft: autogenous saphenous vein, autogenous artery, or prosthetic materials such as Dacron. Other useful methods include splenorenal arterial anastomosis, end-arterectomy, autotransplantation, and combined aortic and renal artery grafting. Other innovative bypass techniques exist for management of the patient with a surgically difficult aorta, including ileorenal, hepatorenal, and mesenteric-renal bypass. With proper selection of patients and appropriate operative repair by an experienced surgeon, excellent results may be expected, with cure or improvement in about 90% of patients with negligible morbidity and mortality.