Revascularization to preserve renal function in patients with atherosclerotic renovascular disease

This article focuses on the performance of renal revascularization for the primary purpose of preserving renal function in patients with significant renal arterial occlusive disease. This approach is usually not applicable to patients with fibrous dysplasia because medial fibroplasia, the most common fibrous disorder, does not compromise renal function and the remaining fibrous diseases, intimal and perimedial fibroplasia, are invariably associated with severe hypertension, which itself mandates operative treatment. There are, however, a significant number of patients with advanced atherosclerotic renovascular disease whose blood pressure is well controlled with medical therapy but in whom such vascular disease poses a grave risk to overall renal function. We review herein current concepts regarding screening, evaluation, and selection of patients with this disease for revascularization to preserve renal function. The underlying rationale for this approach is an increasing awareness that, in selected patients, atherosclerotic renovascular disease represents a surgically correctable cause of progressive renal failure.