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Renal artery stenosis is a well known cause of hypertension, azotemia and flash pulmonary oedema. The treatment of renal artery stenosis by revascularisation has been questioned as randomised studies such as ASTRAL have shown no clinical advantage of revascularisation, as compared to medication only. However, the ASTRAL-study has important limitations as the study population consists of patients with questionable indications for revascularisation, potential patient selection bias and a surprisingly high rate of complications. The authors from seven Swedish hospitals with experience of patients with renovascular disease consider revascularisation to have an important role in treatment of renal artery stenosis in order to: improve bloodpressure control and reduce the need for dialysis and renal transplantation. However, proper patient selection is of major importance. Revascularisation should be based on clinical symptoms and limited to patients with hemodynamically significant stenosis. Selecting the right patients is of major importance. We recommend the new “Guidelines for renovascular disease”, Uppsala, Sweden, for improved evaluation and treatment of patients with renovascular disease.

MeSH