As stated in our Preface and Introduction, one of the prime intentions in publishing this atlas was to put together, in one volume, a personal overview of current knowledge concerning the pathophysiology, clinical and diagnostic evaluation and the clinical treatment of the patient with essential hypertension.

Part of the diagnostic evaluation of the patient with hypertension is consideration of the role of renal arterial disease. However, there is little in the current literature about the pathological, radiographic and clinical natural history correlations of specific renal arterial lesions. Much of this information resides in the literature of the early 1960s written by my dear friends and colleagues at the Cleveland Clinic, Harriet P. Dustan, MD, and Thomas F. Meaney, MD, of the Research Division and Department of Radiology. Their work was importantly supported by the remarkable surgical repair of renal arterial lesions by Eugene Poutasse, MD, and by the pathological studies of these lesions by Lawrence J. McCormack of the Departments of Urology and Pathology, respectively. In contrast to the present state of the art, whereby renal arterial lesions are treated by placement of stents, direct intravascular arterial dilatation or surgically, these renal arterial lesions were carefully excised and then end-to-end arterial reanastomosis was used to reinstate continuity of blood flow to the affected kidney. The patients were followed carefully by periodic radiographic examinations prior to and following the renal arterial surgery, thereby providing a unique presentation of the natural history of renal arterial disease.

Fortunately, Doctor Dustan provided me with some of her slide library of these lesions before her death and, in homage to these outstanding clinicians and investigators, I have included their experiences in this atlas and acknowledge their landmark contributions. These experiences should be of great value to those clinicians interested in the pathophysiology and natural history of hypertensive renal arterial disease. I doubt whether any similar documents are available to the practising physician today. And, on a much more personal note, one might be interested in how and why these physicians were able to perform these procedures at a time when Mason F. Sones, MD, of the Clinic’s Department of Cardiology had only recently introduced his technique of intra-arterial catheterization and arteriography of the coronary arteries. At that time Mason Sones was tremendously preoccupied with the number of patients referred to him for his new procedure of direct coronary artery catheterization and angiography. Hence, at a meeting organized by Harriet Dustan, he agreed to catheterize arteries above the diaphragm (with the exception of the arterial supply to the brain), and Tom Meaney introduced the technique of direct renal arterial catheterization for the diagnosis of renal arterial disease. At the time, renal arteriography was achieved by aortograms, a much inferior technique to visualize the arterial supply to the kidney.