28 patients with renovascular hypertension caused by fibromuscular dysplasia involving one or more renal arteries underwent reconstructive surgery. The renal artery stenosis was bilateral in 5 patients. Total artery occlusion occurred in 3 cases. Arteriography was the most useful diagnostic procedure. The operative technique of choice was replacement using saphenous vein or hypogastric artery. All patients survived. On follow-up, 27 patients (96.4%) were either cured or improved. Isotope nephrography suggested restenosis in 1 case. Our results support an aggressive approach to the diagnosis and surgical treatment of renal artery fibromuscular dysplasia causing hypertension.