The vast majority of renovascular hypertension is treated nowadays resorting to endovascular procedures (angioplasty/stenting). We report a case of malignant hypertension derived from bilateral ostial renal artery occlusion with unfit anatomy for endovascular correction. The patient maintained assymptomatic with controlled arterial tension at the thirteenth yeah of follow-up, due to a splenorenal bypass. A review of the literature and this surgery indications is discussed.