Surgical revascularization

Surgical treatment of renovascular disease changed with the advent of stenting and the introduction of more potent anti-hypertensive medications. Currently, surgical renal revascularization is relegated to patients with recurrent in-stent stenosis, complex fibromuscular disease and renal aneurysms, children and adolescents with renovascular disease, and renal artery bypass or endarterectomy done in conjunction with aortic aneurysm repair or aortofemoral bypass for occlusive disease. Renal artery reconstructions are done with a variety of techniques, and are best done before there is irreversible renal parenchymal damage. Open surgical renal reconstruction has become more complex since the advent of stenting. Careful surgical planning, renal protection, and technical execution of the operation are keys to success.