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One-hundred and eight autologous saphenous veins were used to construct an aortorenal bypass in 94 patients and were followed from five months to nine years. There were three operative deaths. Twelve grafts thrombosed. In seven patients the thrombosis was demonstrated in the early postoperative period. In the other five patients an early postoperative arteriogram was not done, the thrombosis was first demonstrated arteriographically 4(1/2)-9 months following operation. In the latter patients it is impossible to determine when the thrombosis occurred. No graft demonstrated to be patent in the early postoperative period was subsequently found to be thrombosed. Therefore it is likely that almost all thromboses occurred in the immediate postoperative period and were the result of technical errors in the arterial reconstruction. A total of 130 followup arteriograms were done in 75 patients with 89 patent grafts. Long term, serial followup arteriograms were done in 29 patients with 39 vein grafts. Three different patterns were observed: 1) the vein graft maintained its initial size and configuration (62%); 2) the vein graft underwent uniform dilatation throughout its length (20%); and 3) the dilatation progressed to aneurysmal proportions (5%). Significant suture line stenosis developed in one patient who also had recurrent renovascular hypertension. Progression of severity of "apparently insignificant" stenosis or development of a new lesion in the contralateral renal artery was observed in 12 of the 29 patients (41%). These patients serve to emphasize the fact that nephrectomy is ill-advised in patients with renovascular hypertension except under the most demanding circumstances. Finally, there is an urgent need for a careful comparative study of the grafts that are currently being used to construct aortorenal bypasses.

A comparison of lesions discovered by selective renal arteriograms with abnormalities observed on abdominal aortograms was made in 100 consecutive hypertensive patients. Twenty-one lesions not seen on aortograms were found by selection. Eight patients with a normal aortogram had lesions. An abnormality was discovered in at least one study in 58 patients. The increased rate of lesion detection by selective studies outweighs the slight risk of complications.