Renal revascularization as treatment for malignant hypertension.

Twelve patients critically ill with accelerated or malignant hypertension caused by atheromatous renal artery disease were treated by renal revascularization because an intensive program of medical treatment had failed. Seven patients had unilateral stenosis, five patients had bilateral lesions. This aggressive approach was beneficial to all the patients; there was no operative mortality and morbidity was minimal. Blood pressure was adequately controlled in all 12 patients. After a mean follow-up of 42 months, renal function was improved or stable in 10 patients but had deteriorated slightly in 2. Interestingly, one patient who had a higher renin activity in his contralateral nonstenotic kidney was much improved by correction of only the stenosis. The authors recommend early surgical intervention in severe renal artery lesions in cases of accelerated or malignant hypertension refractory to vigorous medical treatment or with rapidly progressive renal failure. An occluded renal artery can be revascularized if the kidney has no gross evidence of infarction, has viable glomeruli and if distal arteries and their intrarenal branches are intact. Reduction of blood pressure and stabilization or restoration of renal function can be expected.