[Therapeutic guide for renovascular hypertension with reevaluation of surgical treatment].

Therapeutic guide for renovascular hypertension has been greatly changed by a development of beta-blockers and captopril, and an introduction of percutaneous transluminal angioplasty (PTA) The accepted opinion was that surgical therapy was superior to drug therapy since Hunt & Strong reported the follow-up results in 1973. However, efficacy of drug therapy was reevaluated by an appearance of beta-blockers and captopril and the number of patients applied to operation was decreased. Further, since PTA was widely used in clinical practice from the end of 1970s, surgical therapy for renovascular hypertension was hardly or never considered. Has the necessity of surgical therapy really ceased to exist? Recently, we encountered 2 cases of bilateral renovascular hypertension and reevaluated the necessity of surgical therapy during the course of treatment. The first case was in a 43-year-old male, for whose bilateral renovascular stenosis a bilateral PTA was applied. One year later a complete occlusion of the right renal artery and re-stenosis of the left renal artery developed. Thus, removal of the right kidney and the auto-transplantation of the left kidney were conducted. The second case was in a 17-year-old female with bilateral renovascular stenosis complicated by moya-moya disease. PTA was conducted for the left kidney with shorter range of stenosis and auto-transplantation was conducted for the right kidney with longer range of stenosis. The prognosis was favorable in both cases and hypertension was cured or improved. We recognized and re-evaluated the necessity of surgical therapy for patients who were unsuccessful to PTA or patients with bilateral renovascular hypertension from our experience and literatures.(ABSTRACT TRUNCATED AT 250 WORDS)