The availability of newer treatment alternatives for patients with renovascular disease has resulted in many patients being referred for surgical intervention in a delayed fashion. As a result of these changes in the type of patients being referred to surgery with more advanced renovascular hypertension and renal excretory dysfunction, vascular surgeons need to be well versed in the variety of surgical renal revascularization techniques. Each of the procedures has its own advocates, but many of these techniques are not applicable in all patients. Familiarity with the various techniques allows the surgeon to have a choice in the method of renal revascularization appropriate for a given clinical situation. Ultimately, the efficacy of any interventional procedure must be considered along with its associated morbidity, mortality, and long-term clinical outcome. All become important factors when considering the optimal primary surgical procedure to treat the patient with renovascular hypertension or renal excretory dysfunction.