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Aortorenal bypass is the preferred method of renal revascularization. However, a n alternative procedure is required in cases where anastomosis t o the diseased aorta cannot be safely or effectively performed. Harnessing the hepatic circulation was first described by Libertino in 1976'. Since Case reportA 15-year-old Chinese girl was admitted in November 1984, following a convulsive seizure. Blood pressure on admission was 180/120 on both In view of the poor control of her blood pressure by antihypertensives and the ischaemic changes of the right kidney, surgery was contemplated. Exploration in January 1985 revealed a rigid, fibrotic abdominal aorta below the origin of the renal artery. The segment of stenotic renal artery shown in the aortogram felt hard and nodular. Other vessels appeared normal.The diseased segment of renal artery was resected and a saphenous vein graft was inserted to join the end of the renal artery to the side of the hepatic artery (Figure 2). Histological examination revealed features of panarteritis and infiltration by lymphocytes, plasma cells and occasional giant cells, consistent with Takayasu's disease.Renal scan one month after surgery demonstrated satisfactory perfusion of the right kidney. Her renal function remained normal, as was the liver function. Eight months postoperatively, her blood pressure was maintained between 120/80 and 130/90 without any medication. DiscussionHypertension is now recognized as a common finding in Takayasu's arteritis. I t is commonly due t o partial obliteration of the renal artery orifices by hyperplastic intimal plaques, though other factors may be contributory. A number of procedures have been used t o treat renovascular hypertension, including patch plasty, resection and replantation, replacement, transaortic endarterectomy, and bypass grafting3. These procedures entail manipulation of the aorta which may itself be involved by the fibrosing and stenosing process. In the thoracoabdominal form of the disease, complex reconstruction employing a long prosthetic graft and one or more autogenous vein grafts is required4. The operation is time consuming, with considerable operative and postoperative risk. In the selected cases of coarctation of the lower abdominal aorta, hepatic circulation can be utilized as a n effective source of blood supply t o the right kidney, as depicted by the above case. The operation is relatively simple, carrying a low mortality and a high success rate. Its role is further enhanced by the fact that the hepatic artery is less frequently involved than the renal arteries in Takayasu's arteritis5.Other options are far from ideal. Even if the iliac arteries are not involved, autotransplantation of the kidney t o the pelvis carries the risk of disturbing the existing collateral circulation, and damage t o the kidney by longer ischaemic time. Perfusion may soon be insufficient from a part of the arterial tree distal to a progressing, stenotic lesion6. O n the other hand, the tight and rigid stenosis would not readily yield t o per...