While balloon angioplasty and surgery are associated with equal rates of improving renal function and hypertension in patients with renal artery stenosis (RAS), the higher rate of post-operative complications associated with the vascular surgical reconstruction makes angioplasty the preferred first-line treatment of RAS among patients requiring intervention. Vascular surgical reconstruction is reserved for a minority of cases. The need for surgical reoperation is 5-15%.

Vascular surgical reconstruction is reserved for a minority of cases. Similar to all surgeries, vascular surgical reconstruction is associated with complications. The need for reoperation is documented in 5-15% of all Renal artery stenosis patients who require surgical intervention.^{[1][2][3][4][5]}

Vascular surgical reconstruction is indicated in specific cases of atherosclerotic RAS^{[1][2][3][4][5]}:

• Involvement of multiple small arteries
• Involvement of early primary branching of the main renal artery
• Renal artery reconstruction during pararenal aortic reconstruction in cases such as aortic aneurysms or aortoiliac occlusive disease

The risk of complications associated with renal artery reconstruction increases in the following conditions:^{[1][2][3][4][5]}:

• Concomitant aortic reconstruction
• Renal insufficiency
• Use of aortic grafts as bypass graft