A 69-year-old white woman who 18 months previously had undergone a right nephrectomy and an aorto-renal artery saphenous vein bypass to her left kidney because of accelerated hypertension underwent angioplasty repair of the saphenous vein bypass, which had become stenotic and was causing accelerated hypertension and renal failure. Angioplasty resulted in improvement in BP control and renal function. This is the first report of a successful angioplasty of an aorto-renal saphenous vein bypass. This case also demonstrates the previously described captopril-induced acute renal failure seen in patients with compromised renal perfusion pressure.