In properly selected patients, the benefits of renal artery reconstruction for renovascular hypertension have been clearly established. Disagreement remains, however, regarding the optimal technique. For most types of left-sided lesions, a splenorenal arterial anastomosis offers decided advantages. Only a single suture line is required and autogenous arterial tissue is employed. Difficulties with a diseased aorta are avoided. The procedure is particularly suitable for a staged approach to bilateral disease or in reoperation for failed prior reconstructions. Our experience with this procedure in 19 patients is reviewed and indications for selection of a splenorenal anastomosis are discussed. There were no deaths, and a single failure due to graft occlusion (5%). Of the remaining 18 patients, 7 are cured and 11 are improved. There were no instances of postoperative renal failure, and renal function improved in all four patients with preoperative renal failure. We conclude that in properly selected patients this procedure is of great usefulness and deserves wider application.