Lasting Antihypertensive Effect of Percutaneous Transluminal Angioplasty of Renal Artery Stenoses in a Child

Percutaneous transluminal angioplasty (PTA) has been developed over the past 8 years as an alternative to reconstructive surgery for renovascular hypertension. We report three cases and review the use of PTA in children with renal artery stenosis. At least 37 cases of PTA have been reported in patients whose ages ranged from 1.3 to 17 years (mean 10 years). Of these, 10 had fibromuscular dysplasia; 13 unspecified unilateral renal artery stenosis; 4 bilateral stenosis; 4 neurofibromatosis; 4 renal transplant; 1 atherosclerosis; and 1 postsurgical stenosis. Nine of 10 patients with fibromuscular dysplasia were cured and 3 of 4 with renal transplant arterial stenosis were cured or improved. There were 11 failures of PTA, including all 4 patients with neurofibromatosis and 1 with transplant arterial stenosis. We conclude that PTA is the treatment of choice for children with hypertension due to fibromuscular dysplasia and should be attempted for stenosis of the transplanted renal artery. Other lesions resulting in renal artery stenosis may not be as amenable to dilation and should be considered on an individual basis.

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Percutaneous transluminal angioplasty for renovascular hypertension in children

Chevalier

Tegtmeyer

Gomez

1987

Pediatr Nephrol

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Transluminale Dilatation und andere nichtoperative Kathetertechniken in der Behandlung der renovaskulären Hypertonie

Grützmacher¹,

Bussmann²

1986

Klin Wochenschr

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The development of percutaneous transluminal techniques has brought up new possibilities for causative treatment of renovascular hypertension. In renal artery stenosis transluminal angioplasty is meanwhile routinely applied; experience with angioplasty to date exceeds by far the number of 1000 published cases. Technical success is obtained in more than 90%. The clinical success in the therapy of reno-vascular hypertension is approximately 76% over all with nearly equal cure and improvement rates. In fibromuscular stenosis clinical success has been obtained in 95% with a cure rate of 56% and improval in 39%. The cure rate is particularly low in patients with atherosclerotic stenosis with 19%, however in 60% improvement has been obtained, resulting in clinical benefit in 79%. Results obtained by surgery seem to be superior to those of dilatation, especially with regard to cure rates. However, the differences are minor and are compensated by the evident advantages of transluminal dilatation, especially its easy application and lower risk. Thus, 8 years after its introduction in nephrology, transluminal dilatation is the therapy of choice in renal artery stenosis. Other nonoperative interventional techniques, including transcatheter aspiration and embolectomy, intraarterial thrombolysis, embolisation and modified angioplasty provided valuable alternatives to usual surgical therapy. However, experience with some of these procedures is still limited. The complication rate of transluminal angioplasty of 10-20%, necessitating surgery in nearly 5%, prohibits its uncritical use.

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Treatment of severe renal artery stenosis by percutaneous transluminal renal angioplasty and stent implantation

et al. 2006

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The clinical course of two children with mid-aortic syndrome and renal artery stenosis (RAS) who suffered from severe arterial hypertension is described. Hypertension was uncontrollable by antihypertensive medication and was managed by percutaneous transluminal renal angioplasty (PTRA) with stent implantation. The pediatric experience with PTRA is limited, and there are only few cases reported with additional stent implantation. Complications of these procedures are well known from experience with adult patients. However, since surgical revascularization may be technically difficult especially in small children, PTRA with or without stenting should be considered as a valuable treatment option in pediatric RAS.

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Lasting Antihypertensive Effect of Percutaneous Transluminal Angioplasty of Renal Artery Stenoses in a Child

Cited by 4 publications

References 6 publications

Percutaneous transluminal angioplasty for renovascular hypertension in children

Percutaneous transluminal angioplasty for renovascular hypertension in children

Transluminale Dilatation und andere nichtoperative Kathetertechniken in der Behandlung der renovaskulären Hypertonie

Treatment of severe renal artery stenosis by percutaneous transluminal renal angioplasty and stent implantation

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