One hundred fifty-four patients with renovascular injuries were analyzed to gain insight into the mortality, morbidity and indications for immediate nephrectomy versus arterial revascularization. Arterial revascularization is seldom indicated in patients with a normal contralateral kidney who have multiple associated injuries, hilar injuries, long segmental arterial injuries or prolonged renal ischemia. An attempt at renal artery revascularization is justified with bilateral injuries, when only one kidney is present or when a solitary artery injury can be repaired by simple lateral arteriorrhaphy.