Currently, the majority of adults presenting for operative treat ment of renovascular disease demonstrate diffuse atherosclerosis in combination with severe hypertension and excretory renal insufficiency. When renal artery atherosclerosis is aortic in origin and involves both or multiple renal arteries, the procedure of renal artery endarterectomy can be especially useful. As with all methods of renal reconstruction, flawless surgical technique plays the dominant role in determining postoperative patency of renal artery repair. This discussion will emphasize the general strategy of operative management, surgical exposure and technique of endarterectomy, and the clinical outcome of these methods.
