ABSTRACT
Few areas of vascular disease have received such intense clinical research focus with paradigm shis in management opinions as renovascular disease. e pathologies giving rise to renovascular disease are varied ranging from bromuscular dysplasia (FMD) to arteriosclerosis. Atherosclerotic renovascular disease is by far the most common cause for this condition. Vascular surgeons have been aware of renovascular disease and involved in its treatment since the 1970s when this disease was considered to be relatively rare and within the clinical remit of major vascular centres. With the advent of CT and MR scanning, and increased clinical awareness, atherosclerotic renal artery stenosis presents regularly to all vascular surgeons. In the days of relatively ineective agents to control
hypertension and arteriosclerosis, there was an undoubted clinical benet from surgical renal artery reconstruction. With the advent of the endovascular era and in particular renal stent angioplasty, there was an explosion of intervention, but during the same time period, optimal medical management of hypertension and arteriosclerosis made major advances. Recent experimental studies have given insights into the complexity of ischaemic nephropathy and renal arteriosclerosis which begins to explain the clinical realization that revascularization of renal artery stenosis in the majority of patients with atherosclerotic renal artery disease has no benet over optimal medical therapy. is chapter will discuss the pathophysiology, diagnosis and management of renal artery disease in addition to the techniques and current indications for renal arterial revascularization.
