Only when percutaneous transluminal angioplasty is not technically feasible because of extensive disease in the branches of the renal artery is saphenous vein bypass grafting recommended. Sometimes complete surgical revascularization requires microvascular techniques that can only be performed ex vivo with autotransplantation of the kidney. Medical treatment is always preferable to nephrectomy in young patients whose kidneys cannot be revascularized for technical reasons. Compared with fibrous disease, atherosclerotic lesions respond less well to surgery and angioplasty, presumably because the patients are older and have more extensive vascular disease within the kidneys and throughout the vascular system. Hypertension may persist, and surgical complications are more common.
Surgical mortality is higher than in young patients with fibrous dysplasia of the renal artery.
Placement of a stent has reduced the risk of restenosis. The decision to perform surgery must be based on the patient's overall status, age, and prior response to medical therapy and the type and location of renal arterial disease and its threat to renal function. When possible, surgery should involve repair and revascularization instead of nephrectomy. All rights reserved.