Renal revascularization: indications and results.

Although the prevalence of renovascular hypertension is low, clinical criteria can select a population in which renovascular hypertension is significantly more common (prevalence of 15%). In these selected patients, it is appropriate to proceed to a screening modality to look for a significant renal artery stenosis. Choices of the noninvasive methods include captopril-enhanced renal scintigraphy, magnetic resonance (MR) angiography, and intravenous digital subtraction renal angiography (DSRA). Intraarterial DSRA or conventional arteriography may also be used to reliably detect renal artery stenosis, with the advantage that both the diagnostic and the interventional procedure can be performed at the same setting. A high percentage of a group of patients who are selected by means of clinical and arteriographic studies will benefit from revascularization. Thus, the renal artery angioplasty may be performed during the arteriogram in which the stenosis is confirmed.