Surgery of the renal arteries

Hypertension is a pervasive disease affecting between 10% and 15% of the population. Hypertension is manifested silently by an accelerated rate of atherosclerosis leading to increased incidence of cardiovascular, cerebrovascular, and peripheral vascular morbidities and deaths. Through activation of the renin-angiotensin axis, renovascular disease (RVD) accounts for approximately 5% of this hypertensive population. Recently, the relationship between renovascular occlusive disease and progressive renal insufficiency has been delineated and termed ischemic nephropathy. Patients with ischemic nephropathy present with hypertension in conjunction with elevated serum creatinine. It has been estimated that 15% of patients initiating dialysis each year have renovascular disease as the origin of their renal dysfunction. Renal dysfunction is due to a global reduction in renal perfusion, most often as a result of bilateral renal artery occlusive disease, although a mild form of renal insufficiency can be brought on by unilateral occlusive disease due to the effects of the renin-angiotensin system on the contralateral kidney. Historically, treatment of RVD has been centered on interrupting the renin-angiotensin axis and curing the resultant hypertension and its associated morbid disease. Currently, repair efficacy has been realized with concurrent retrieval of excretory renal function and cure of renovascular hypertension.