Besides antihypertensive drug treatment and reconstructive surgery, the percutaneous transluminal angioplasty became an established treatment modality for renal artery stenosis since the late 70's. The treatment aimed at curing the renovascular hypertension, at normalizing and improving of both compensated and decompensated renal insufficiency in order to avoid prolonged hemodialysis after acute renal failure. Endovascular procedures contributed significantly to reach a normotensive state, particularly in cases with renal artery stenosis concomitant with fibromuscular dysplasia and gives similar results as open surgical methods if certain morphological features are considered. However, surgery is generally more effective than endoluminal treatment when all forms of renal artery stenosis are considered together. This holds true in particular for ostial stenosis, complete obstruction of the renal artery, aneurysms and a multitude of rare renovascular diseases. Surgery should be first line treatment to preserve or improve the renal function. According to the pertinent literature, endovascular methods should be considered first for the treatment of renovascular hypertension. Despite the frequent repetition of potential advantages of PTA, a first direct comparison of both modalities demonstrated better primary results after surgical treatment. Even the total cost were similar since PTA requires frequent follow-up with short intervals necessitating secondary interventions.