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Segmental renal artery embolization for treatment of pediatric renovascular hypertension
C L Teigen1, S E Mitchell, A C Venbrux
1Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore.
Insights
Selective intrarenal arterial embolization offers a safe and effective cure for pediatric renovascular hypertension. This minimally invasive treatment eliminates the need for antihypertensive medications in children with identified arterial lesions.
Area of Science:
- Pediatric Nephrology
- Interventional Radiology
- Vascular Surgery
Background:
- Renovascular hypertension in children poses significant health risks.
- Traditional treatments like surgical resection can be invasive.
- Identifying the precise vascular lesions is crucial for effective treatment.
Observation:
- Selective intrarenal arterial embolization was employed in three pediatric cases.
- Renal vein renin sampling, with and without furosemide, aided lesion localization.
- Angiography successfully identified vascular abnormalities in all patients.
Findings:
- Embolization achieved complete cure in all three children, eliminating antihypertensive medication dependence.
- The procedure resulted in minimal loss of renal parenchyma.
- Treatment outcomes correlated well with pre-procedural diagnostic sampling.
Implications:
- Intrarenal arterial embolization is a viable, safe alternative to surgery for pediatric renovascular hypertension.
- This technique is particularly beneficial for lesions not suitable for balloon angioplasty.
- Minimally invasive embolization preserves renal function and improves patient outcomes.
Abstract:
Selective intrarenal arterial embolization was used to treat three children with documented renovascular hypertension. Embolization resulted in complete cure (ie, elimination of all antihypertensive medicines) in all three patients and caused only minimal loss of renal parenchyma. Renal vein renin sampling, including sampling after furosemide administration, correlated well with the location of identified vascular lesions and helped direct selective angiography when lesions were not found initially. Intrarenal arterial embolization is a safe, effective alternative to surgical resection in the treatment of renovascular hypertension in children who have identifiable intrarenal arterial lesions not amenable to balloon angioplasty.