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Interventional radiology for renovascular hypertension in children
Clare A McLaren1, Derek J Roebuck
1Department of Radiology, Great Ormond Street Hospital, London, United Kingdom. mclarc@gosh.nhs.uk
Insights
Pediatric renovascular hypertension, often caused by fibromuscular dysplasia, requires specialized interventional radiology. Diagnostic angiography and interventions like angioplasty are key for treating this rare pediatric condition.
Area of Science:
- Pediatric Nephrology
- Interventional Radiology
- Vascular Medicine
Background:
- Pediatric renovascular hypertension is a rare but significant clinical issue.
- Unlike adults, children often have fibromuscular dysplasia or other genetic syndromes causing this condition.
- Renovascular disease in children can affect multiple arteries, including the aorta and cerebral vessels.
Purpose of the Study:
- To highlight the crucial role of interventional radiology in diagnosing and managing pediatric renovascular hypertension.
- To compare the utility of diagnostic and interventional techniques in pediatric patients.
- To review treatment options for renovascular hypertension in children.
Main Methods:
- Review of diagnostic angiography for renal artery imaging.
- Evaluation of interventional techniques such as angioplasty, stenting, and ethanol ablation.
- Assessment of renal vein renin sampling in pediatric cases.
Main Results:
- Diagnostic angiography remains superior for visualizing pediatric renal arteries, especially smaller branches.
- Renal vein renin sampling is particularly useful in children due to the segmental nature of their arterial disease.
- Angioplasty is highly successful technically and clinically, with stenting reserved for failures and ethanol ablation for focal renin-producing areas.
Conclusions:
- Interventional radiology is essential for the comprehensive care of pediatric renovascular hypertension.
- Angioplasty is the primary successful intervention, offering significant clinical improvement.
- Less-invasive imaging methods are less effective than angiography for detailed renal artery assessment in children.
Abstract:
Pediatric renovascular hypertension is an uncommon but important clinical problem. Atherosclerosis is rare in children, who typically suffer from fibromuscular dysplasia, neurofibromatosis type 1, Williams syndrome, or certain other rare conditions. Children with renovascular disease often have involvement of other arteries including the aorta and mesenteric and cerebral vessels. The pediatric interventional radiology service has a vital role in the diagnosis, evaluation, and treatment of renovascular hypertension. Renal vein renin sampling appears to be more useful in children than in adults, because their arterial disease is more often bilateral and segmental. Diagnostic angiography is still superior to less-invasive methods of imaging the renal arteries, especially the smaller branches. Interventional options include angioplasty, stenting, and ethanol ablation. Angioplasty is almost always technically successful and usually gives a worthwhile clinical improvement. Stenting is only used in children when angioplasty fails. Ethanol embolization may be appropriate in children with focal renin-producing areas that are untreatable by angioplasty.
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