Published online July 3, 2006
PEDIATRICS Vol. 118 No. 1 July 2006, pp. 268-275 (doi:10.1542/peds.2005-2642)
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Angioplasty for Renovascular Hypertension in Children: 20-Year Experience

Rukshana Shroff, MRCPCHa, Derek J. Roebuck, FRCRb, Isky Gordon, FRCRb, Roger Davies, FRANZRb, Suzanne Stephens, FRCPCHa, Stephen Marks, FRCPCHa, Mark Chan, MRCPCHa, Maria Barkovics, FRCRb, Clare A. McLaren, DCR (R)b, Vanita Shah, FIBMSa, Michael J. Dillon, FRCPCHa and Kjell Tullus, FRCPCHa

a Departments of Nephrourology
b Radiology, Great Ormond Street Hospital for Children, London, United Kingdom

OBJECTIVE. Our aim was to evaluate the clinical outcomes, safety, and efficacy of percutaneous transluminal angioplasty for renovascular hypertension in children.

METHODS. A retrospective review of data for all children with renovascular hypertension who underwent percutaneous transluminal angioplasty at a single center between 1984 and 2003 was performed. Patients with renal transplants and inflammatory multisystem diseases were excluded.

RESULTS. Thirty-three children, 1.9 to 17.9 years of age (median: 10.3 years), underwent renal angioplasty and/or stenting. Underlying syndromes were present in 10. On angiograms, 16 had bilateral renal artery stenosis, 15 intrarenal disease, 8 aortic stenosis, and 7 cerebrovascular disease. Forty-eight percutaneous transluminal angioplasty procedures were performed, including 15 stenting procedures. There was a high rate of restenosis after stenting (7 of 19 cases, compared with 2 of 27 cases after balloon dilation). Outcomes were cured (ie, blood pressure normal without treatment) for 9 patients, improved blood pressure with same or reduced treatment for 7, blood pressure maintained in >95th percentile because of cerebrovascular disease for 2, no change in blood pressure despite technical success for 10, and technical failure for 5. Blood pressure control improved in 11 of 13 children who had main renal artery disease alone and in 6 of 20 with associated intrarenal disease or stenoses in other vascular beds. There was 1 procedure-related death and 5 minor complications.

CONCLUSIONS. Angioplasty produced clinically worthwhile improvement for ~50% of patients. High incidence rates of extrarenal involvement and intrarenal disease and a high restenosis rate after stenting accounted for poor blood pressure control in the rest.

Key Words: renovascular hypertension • child • renal artery stenosis • percutaneous transluminal angioplasty • stent • restenosis

Abbreviations: RVH—renovascular hypertension • RAS—renal artery stenosis • PTA—percutaneous transluminal angioplasty • NF1—neurofibromatosis type 1 • BP—blood pressure • FMD—fibromuscular dysplasia • DMSA—dimercaptosuccinic acid

Accepted Feb 6, 2006.




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