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

Abstract

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.

Treatment of a recurrent renal artery stenosis and stent fracture using a drug eluting stent in a pediatric patient

“…In cases, angioplasty had been reported as very useful, but other authors have reported poor long-term results needing the use of stents [1,[10][11][12][13][14][15]. In our patient, the angioplasties performed obtained an excellent immediate result, but really poor intermediate or long-term results.…”

“…This can be achieved through percutaneous angioplasty and surgical interventions. In severe cases, where none of the previous treatments is successful, a nephrectomy is an alternative [1][2][3][4][5][6][7][8][9].…”

“…Percutaneous transluminal renal angioplasty has been considered the treatment of choice for revascularization [1,[4][5][6]. In cases, angioplasty had been reported as very useful, but other authors have reported poor long-term results needing the use of stents [1,[10][11][12][13][14][15].…”

“…The use of stents has proven to be of great benefit for the arterial revascularization, improving the renal function and controlling the hypertension. It has become the recommended treatment for severe stenosis and difficult lesions such as ostial and restenotic lesions [1,[4][5][6][7]. We took this line of treatment for our patient, since the preferred route was less invasive, and the angioplasty alone was not successful at long term as desired.…”

“…In children, renal artery stenosis (RAS) is most commonly caused by fibromuscular dysplasia, although it may also appear in association with neurofibromatosis, Takayasu's arteritis, Moyamoya disease, thrombosis, and vascular malformations [1]. Rarely, the most common cause of RAS in adults, which is atherosclerosis [2] may also be observed in the pediatric population [3].…”