ABSTRACT
Although generally believed to be a rare cause of hypertension, atherosclerotic renal artery stenosis (RAS) is a common finding in selected patient populations. In the general population of hypertensive patients, from 1% to 6% have some element of RAS. However, there are several clinical clues that suggest a greater likelihood of RAS in certain subsets of patients, including the presence of coronary, carotid, abdominal aortic, and lower extremity arterial occlusive disease. In patients with aortoiliac occlusive disease or abdominal aortic aneurysmal disease, the prevalence of significant bilateral RAS ranges from 33% to 45%. Once a stenosis of the renal artery due to atherosclerosis has been identified, the optimal method of treatment must be chosen. Three alternatives presently exist: medical therapy alone, surgical bypass or endarterectomy, or percutaneous transluminal angioplasty and/ or endovascular stent deployment. To make the appropriate choice, a basic understanding of the complication rates and clinical outcomes for each option is necessary.
