ABSTRACT
OBJECTIVES: This article describes the long-term outcome of surgical treatment in children with renovascular hypertension (RVH) over a 40-year period. DESIGN: Retrospective study. MATERIALS AND METHODS: Twenty-five consecutive patients, aged 5-21 years, underwent renal artery (RA) repair from 1967 to 1995. The disease consisted of fibromuscular dysplasia in 17 patients, Takayasu's arteritis in 7 and neurofibromatosis type 1 in one patient. RESULTS: Twenty-nine RAs were repaired. Primary procedures included aortorenal bypass (ARB) with prosthesis in 10 RAs, autologous vein in five or internal iliac artery in four as conduits, direct reimplantation (DR) in four and nephrectomy in two RAs. Immediate graft failure occurred in three patients despite no peri-operative deaths. After a mean follow-up of 24.4 years, seven patients required secondary nephrectomy. Autologous ARB or DR showed better RA patency and fewer chances for secondary nephrectomy than prosthetic ARB. Hypertension was cured or improved in 21 patients. The overall cumulative survival rate at 20 years was 84%. All five deaths, observed a mean of 12.6 years after the initial operation, were attributed to cardiovascular events. CONCLUSIONS: Surgical treatment, especially autologous ARB or DR, seems to provide durable results for paediatric RVH. Long-term observation and control of hypertension is mandatory.
Subject(s)
Aorta, Abdominal/surgery , Hypertension, Renovascular/surgery , Renal Artery/surgery , Vascular Surgical Procedures/methods , Adolescent , Anastomosis, Surgical/methods , Angiography , Blood Pressure/physiology , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Hypertension, Renovascular/etiology , Hypertension, Renovascular/physiopathology , Male , Renal Artery Obstruction/complications , Renal Artery Obstruction/diagnostic imaging , Renal Artery Obstruction/surgery , Retrospective Studies , Stents , Time Factors , Treatment Outcome , Young AdultABSTRACT
Pediatric renovascular hypertension (RVH) associated with neurofibromatosis 1 (NF1) is a rare entity that is often resistant to endovascular treatment. A 12-year-old girl with NF1 and hypertension presented with severe stenosis of the right main renal artery and its posterior segment, the latter of which thrombosed spontaneously, and total occlusion of the celiac artery with rare branching of the accessory middle colic artery. She underwent successful reconstruction of the anterior segment of the right renal artery, and has been free of medication for ten years. A review of the recent literature suggests that renal artery bypass remains the best treatment in pediatric RVH with NF1.
