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Renovascular Hypertension Surgery

Surgical revascularization for renal artery stenosis-induced hypertension.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Üroloji department. Book Appointment →

What is Renovascular Hypertension Surgery?

Renovascular hypertension surgery is performed to restore renal arterial perfusion in patients with hemodynamically significant renal artery stenosis (RAS) causing secondary hypertension or ischemic nephropathy. The two main etiologies are atherosclerotic RAS (90%, typically ostial in older patients) and fibromuscular dysplasia (10%, mid-distal segments in younger women).

Modern management favors optimal medical therapy with selective revascularization for resistant hypertension, flash pulmonary edema, deteriorating renal function or significant fibromuscular dysplasia. Percutaneous transluminal renal angioplasty (PTRA) with stenting is first-line; open surgical revascularization (aortorenal bypass, transaortic endarterectomy) is reserved for endovascular failures.

Symptoms

Resistant hypertension despite three antihypertensives
Sudden worsening of previously controlled hypertension
Flash pulmonary edema (Pickering syndrome)
Unexplained progressive renal insufficiency
ACE inhibitor-induced acute kidney injury
Asymmetric kidney size on imaging
Abdominal bruit on examination

Risk Factors

Atherosclerotic disease and advanced age
Smoking
Hypertension and diabetes mellitus
Hyperlipidemia
Female gender for fibromuscular dysplasia
Family history of vascular disease
Concomitant peripheral arterial disease

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Resistant hypertension on three or more drugs
  • Sudden hypertension onset over age 55
  • Flash pulmonary edema episodes
  • Rising creatinine on ACE inhibitor or ARB
  • Abdominal bruit with hypertension
  • Atrophic kidney on imaging

Treatment Methods

01
Optimization of medical therapy (ACE inhibitor or ARB, statin, antiplatelet)
02
Lifestyle modification and risk factor control
03
Confirmation with CTA, MRA or duplex ultrasound
04
Percutaneous transluminal renal angioplasty with stent for atherosclerotic RAS
05
Balloon angioplasty alone for fibromuscular dysplasia
06
Open aortorenal bypass with saphenous vein for complex anatomy
07
Transaortic endarterectomy for ostial atherosclerotic disease
08
Ex vivo repair and autotransplantation in selected cases
09
Long-term blood pressure monitoring and renal function follow-up

Which Department to Visit?

You can visit our Üroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.