Early and Long-term Results after Reconstructive Surgery in 42 Children and Two Young Adults with Renovascular Hypertension due to Fibromuscular Dysplasia and Middle Aortic Syndrome

Abstract

Reconstructive surgery for pediatric RVH yields good results at every age and every type of lesion. However, these children should be followed up closely and to avoid early cardiovascular disease and death in later life, surgery should not be delayed.

Interventions in children with renovascular hypertension: A 27-year retrospective single-center experience

“…Previous studies looking at percutaneous angioplasty for pediatric RVH have reported varying success in BP control ranging from 54% to 94% . Likewise, centers that have extensive surgical experience with this disease have reported excellent control of BP with cure rates ranging from 56%–70%, improvement in 23%–44%, and failure rates of 3%‐32% . Indeed, this variability can stem from multiple confounders including primary etiology of RVH (intrinsic stenosis of a renal artery vs thrombosis of an otherwise normal vessel), severity/location/number of lesions in each patient, aggressiveness of medical therapy, method of balloon angioplasty (eg, whether more aggressive techniques, such as high‐pressure angioplasty and/or cutting balloons are used), if stenting was used, and whether BP was followed short‐term vs long‐term.…”

“…Previous studies that looked at treatment of RVH in children have either focused on surgical management or transcatheter treatment and hence till date these cohorts have not been compared . Our study spans 3 decades, and therefore, a variety of management strategies were in vogue during different eras of our study period.…”

“…Approximately two thirds of pediatric hypertension is from secondary causes, with renal parenchymal and renovascular disease being the commonest causes . Renovascular hypertension (RVH) can be caused by isolated renal artery stenosis (RAS) and/or obstruction within the suprarenal abdominal aorta known as middle aortic syndrome (MAS) . This leads to decrease in perfusion pressure in the renal arteries, activation of the renin‐angiotensin system and subsequent blood pressure elevation.…”

“…[6][7][8] RVH, when severe, is usually not responsive to medical therapy alone 9 and a variety of procedures such as balloon angioplasty, stent implantation, and surgery (such as patch augmentation, bypass graft, or renal autotransplantation) are used. 4,[10][11][12][13] Traditionally, patients with RVH refractory to medical therapy underwent surgical intervention. 4,14,15 With the advancement in transcatheter techniques, it is now possible to perform angioplasty and/or stenting in smaller children that might not have been considered surgical candidates in the past.…”

“…4,[10][11][12][13] Traditionally, patients with RVH refractory to medical therapy underwent surgical intervention. 4,14,15 With the advancement in transcatheter techniques, it is now possible to perform angioplasty and/or stenting in smaller children that might not have been considered surgical candidates in the past. There are no contemporary studies to compare the outcomes between surgery and catheter-based interventions in children with RVH.…”