J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text PDF] （in Japanese / 6838KB） [Members Only And Two Factor Auth.]

J.Jpn. Surg. Soc.. 82(7): 781-790, 1981

Original article

SURGICAL TREATMENT FOR RENOVASCULAR HYPERTENSION: OPERATIVE INDICATION AND SELECTION OF ITS PROCEDURE

Second Department of Surgery, Kobe University School of Medicine
*) Takasago City Hospital
**) Kondo Hospital
***) First Department of Medicine, Kobe University School of Medicine

Masayoshi Okada, Hiroyuki  Horii, Hajime Yamamoto, Yushi Matsumoto, Katsuya Hisano, Hiroaki Tsuruta, Takeshi Goto, Tsutomu Shida, Kazuo Nakamura, Sakae Asada*), Ko Hashimoto**), Hisashi Fuhusaki***), Kinji Kurose***), Hiroshi  Sano***)

Fourteen cases with renovascular hypertension were operated on during a period of fifteen years. Diagnosis of this lesion was preoperatively confirmed by drip infusion pyelography, renography, measurement of renin activity, and angiography of the renal artery. Especially, renin activity (a renin vein ratio of 1.5 or more) and renal angiogram (stenosis more than 75 %) revealed indicator to decide surgical intervention.
Operative methods consists of bypass with Dacron graft in 4 cases, bypass with saphenous vein in 3 cases, reimplantation in 2 cases, patch grafting in 1 case, spleno-renal anastomosis in 1 case and nephrectomy in 3 cases, whose renal function was remarkably destroyed.
Follow up study was performed from 14 years to 1 year (mean 6 years and 8 months) after surgery. 13 patients are doing well except for 1 case who died of uremia 2 years after reimplantation of right renal artery. Blood pressure and renin activity level after surgery are so good controlled that they are able to return to full work.
For the patients with a significant stenosis of the renal artery and high renin activity, aorto-renal anastomosis (saphena-interposition) should be recommended as a renal reconstruction.

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