Atherosclerotic renovascular disease is a relatively common etiology of end-stage renal failure and is associated with significant morbidity and mortality. Despite nearly four decades of clinical experience in renal artery revascularization, few randomized controlled trials compare medical management, surgical revascularization, and percutaneous intervention. To date, the overwhelming majority of data have been obtained via retrospective reviews, and such data often fail to address the clinical or anatomic variables that are predictive of long-term salvage of excretory function. This subject is increasingly important since the advent of renal artery stenting and the more liberal application of this technique. This chapter reviews our experience with renal artery reconstruction for the preservation of excretory function as well as the available literature in an attempt to identify variables predictive of outcome.
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