surgical management of flash pulmonary edema secondary to renovascular hypertension background flask pulmonary edema fpe may be a manifestation of renovascular hypertension rvhtn and unresponsive to antihypertensive therapymethods response to antihypertensive therapy and perioperative outcomes were determined in 5 consecutive patients with fperesults a mean of 23 admissions for the treatment of fpe were observed despite a mean cardiac ejection fraction of 60 preoperative treatment was attempted for 12 days and included ventilatory support n 3 and hemodialysis n 2 total decreased renal perfusion was demonstrated by arteriography and radionuclide scans no patient having a functional contralateral kidney renal revascularizations were not associated with mortalities 1 patient experienced atalectasis requiring bronchoscopy all patients were extubated within 48 hours of surgery a significant reduction in blood pressure bp 46 and serum creatinine cr 53 p or 005 was observed a mean of 1 antihypertensive medication was required at discharge compared with 34 on admission at followup mean 57 months all patients remain cured of fpeconclusions medical management was unsuccessful in the treatment of fpe renal revascularization was associated with low morbidity and mortality control of bp restoration of renal function and cure of fpe these data suggest surgical intervention is the optimal mode of treatment of rvhtn associated with fpe