From 1976 to 1981, 22 patients were treated for atherosclerotic renovascular disease and with widespread atherosclerosis. The average age was 56 years. Preoperatively, the average blood pressure (BP) was 211/123 mm Hg. The standard operation was aortorenal bypass, associated with resection of an abdominal aortic aneurysm in three cases. Four patients had nephrectomy. Most patients were referred after failure of a previous renal revascularization procedure. In three patients, most of the renal arterial system was thrombotic. All patients had preoperative Swan-Ganz catheter placement for monitoring of fluid balance, filling pressure, and cardiac output. Intravenous vasodilators were used to control BP and to reduce the afterload on the left ventricle. There were no operative deaths. The average postoperative BP was 136/81 mm Hg. Three patients had improvement in renal function, and one was able to stop hemodialysis after operation. Because of a low mortality and overall satisfactory results, patients with atherosclerotic renovascular hypertension should be considered for vascular reconstruction.