Treatment of Neurofibromatosis Associated Renal Artery Stenosis with Hypertension by Percutaneous Transluminal Angioplasty

Mallmann, Renata; Roth, F

doi:10.3109/10641968609046609

Cited by 10 publications

(13 citation statements)

References 12 publications

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“…Although 1 out of 3 cases with NF was "failed" as initial technical and clinical result, all cases were "improved" in follow up period. So we agree with other studies (14,15,26) that PTRA should be a treatment of choice in NF 1 patients.…”

Section: Discussionsupporting

confidence: 95%

“…Review of the literature, reveals slightly better results for PTRA in FMD and in TA (17,(21)(22)(23), whereas the results for renal artery stenosis due to NF are rather disappointing (24,25). But CASALINI et al (15) and MALLMAN et al (26) revealed that PTRA should be a treatment of choice also in NF patients. FOSSALI et al (14) also reported that surgical revascularization could be performed in more complex cases in which PTRA fails or complications occur.…”

Section: Discussionmentioning

confidence: 90%

“…The localization of the stenotic lesion in the renal artery also seems to influence of outcome of PTRA : an isolated lesion in the mid or distal part of the artery has a better outcome than lesions near the origin of the artery or long or multipl stenoses (14,26). Also, it is reported that patients with unilateral renal artery stenoses, discrete stenoses (Ն 10 mm), and residual stenosis (Ն 20%) have better blood pressure response (5).…”

Section: Discussionmentioning

confidence: 94%

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Percutaneous Balloon Angioplasty of Renovascular Hypertension in Pediatric Cases

Bayrak

Numan

Cantasdemir

et al. 2008

Acta Chirurgica Belgica

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Section: Discussionsupporting

confidence: 95%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 94%

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Percutaneous Balloon Angioplasty of Renovascular Hypertension in Pediatric Cases

Bayrak

Numan

Cantasdemir

et al. 2008

Acta Chirurgica Belgica

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“…The nature of the vascular involvement in neurofibromatosis has tended to prompt suggestions that surgery is unlikely to resolve the problem, especially as the lesions may be diffuse. Angioplasty was of benefit in temporarily resolving the aortic stenosis but unlike previous reports6 the stenosis recurred.…”

Section: Discussioncontrasting

confidence: 67%

Hypertension secondary to progressive vascular neurofibromatosis

Kurien

John

Milford

1997

Archives of Disease in Childhood

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A 4 year old girl with neurofibromatosis type 1 (NF1) was referred for hypertension. An aortogram showed narrowing of the left main renal artery. An angiogram three and a half years later showed coarctation of the abdominal aorta. She underwent aortoplasty but the stenosis recurred. Vascular involvement in NF1 may be progressive and requires long term follow up. (Arch Dis Child 1997;76:454-455) Keywords: neurofibromatosis; coarctation; renal artery stenosis; hypertension Vascular lesions are widely recognised to complicate neurofibromatosis type 1 (NF1) and include stenoses of the renal arteries, mesenteric artery, and aorta. We describe a child with hypertension complicating NF1 in whom renal artery stenosis was rapidly diagnosed but who later developed abdominal aortic coarctation. This case highlights the importance of measuring the blood pressure annually in children with NF1 and repeated meticulous catheter angiographic investigations in those who are hypertensive. Case reportA 4 year old girl suVered a minor head injury while playing. Two hours later she developed progressive loss of function in the left arm and left leg and was admitted to the local hospital where a diagnosis of a right extradural haematoma was made. She was hypertensive and was noted to have approximately 20 café au lait spots over her abdomen, back, and arm and pigmentation in her right axilla. Her sister, brother, mother, and maternal grandmother also had café au lait spots.On admission to this hospital she was well but her blood pressure was 147/100 in the left arm. Her left hemiparesis was resolving; no other abnormality was found. Renal function was normal, vanillylmandelic acid excretion was normal and echocardiography showed mild left ventricular hypertrophy and no structural abnormality. A renal ultrasound scan and dimercaptosuccinic acid scan showed two normal kidneys. Recumbent plasma renin samples were normal. A renal angiogram demonstrated a left renal artery narrowed at its origin from the abdominal aorta. The right renal, coeliac, and superior mesenteric arteries appeared normal.Hypertension persisted despite treatment with lisinopril. Two weeks after discharge she was admitted to her local hospital with severe frontal headache, twitching of her right arm, and increasing drowsiness. She was transferred to our care. Blood pressure control was improved by captopril and labetalol and her neurological status returned to normal.She was admitted 14 months after her original presentation because of poor blood pressure control and underwent balloon angioplasty of the left main renal artery stenosis. Her antihypertensive medication remained unchanged until repeat angiography 3.5 years after presentation that showed a 3 cm long stenosis of the abdominal aorta below the superior mesenteric artery at the level of the renal arteries. Lateral imaging (fig 1) demonstrated that the aorta was narrowed in the anterior-posterior diameter by 50% (normal aorta 5.9 mm, narrowed segment 2.7 mm). The main renal arteries appeared slightl...

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“…8,13,[16][17][18]24,[37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] In patients with peripheral arterial stenoses, vascular intervention may be indicated to ameliorate claudication 11,12,[16][17][18]24,52,[54][55][56] or prevent critical limb ischemia and limb loss. In those with splanchnic artery stenoses vascular intervention may be mandatory to enable enhancement of bowel perfusion.…”

Section: Vascular Interventionmentioning

confidence: 99%

Neurofibromatosis Type 1: From Presentation and Diagnosis to Vascular and Endovascular Therapy

Delis

Gloviczki²

2006

Perspectives in Vascular Surgery and Endovascular Therapy

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Neurofibromatosis type 1, also called von Recklinghausen's disease, is an autosomal dominant disorder linked to chromosome 17, characterized by growth impairment of the neural crest cells (ectoderm) manifested by multiple neural tumors, cutaneous pigmentations, and Lisch nodules. Disease phenotype develops with time, making its penetrance almost complete by 5 years of age. Compression of the gastro-intestinal, urinary, or pulmonary tracts by visceral neurofibromas may generate serious complications. Neurofibromatosis type 1 is remarkable for its association with occlusive (stenoses) or aneurysmal arterial disease affecting predominantly the renal arteries and less often the abdominal aorta (middle aortic syndrome), and mesenteric and peripheral arteries. Appraisal of existing literature reveals that timely vascular intervention by way of conventional surgery and/or endovascular therapy may provide patients with effective and durable treatment. The far greater propensity for malignant connective/soft-tissue neoplasms and vascular disease in neurofibromatosis type 1, amid potential complications from the gastro-intestinal, urinary, and pulmonary tracts, leads to a significantly increased morbidity and decreased life expectancy. Neurofibromatosis type 1, from presentation and diagnosis to its treatment, is reviewed, with emphasis on vascular disease and its management with open vascular surgery and endovascular therapy.

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Treatment of Neurofibromatosis Associated Renal Artery Stenosis with Hypertension by Percutaneous Transluminal Angioplasty

Cited by 10 publications

References 12 publications

Percutaneous Balloon Angioplasty of Renovascular Hypertension in Pediatric Cases

Percutaneous Balloon Angioplasty of Renovascular Hypertension in Pediatric Cases

Hypertension secondary to progressive vascular neurofibromatosis

Neurofibromatosis Type 1: From Presentation and Diagnosis to Vascular and Endovascular Therapy

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