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Published on: July 7, 2013
Remedial operations for failed endovascular therapy of 32 renal artery stenoses in 24 children
Jonathan L Eliason1, Dawn M Coleman2, Enrique Criado2
1Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA. jonaelia@med.umich.edu.
Insights
Pediatric renovascular hypertension (RVH) treatment with percutaneous transluminal angioplasty (PTA) can fail, necessitating complex surgical repairs or nephrectomy, especially in younger children. This study analyzes PTA failures and surgical outcomes.
Area of Science:
- Pediatric Nephrology
- Interventional Cardiology
- Pediatric Surgery
Background:
- Percutaneous transluminal angioplasty (PTA) is used for pediatric renovascular hypertension (RVH).
- Complications and failure modes of PTA in children are not well-defined.
- This study investigates PTA failures and subsequent surgical management in pediatric RVH.
Purpose of the Study:
- To examine the types of failures encountered after renal PTA in children with RVH.
- To evaluate the outcomes of surgical interventions for these PTA failures.
- To identify factors influencing the need for complex repairs or nephrectomy.
Main Methods:
- Retrospective review of 24 children who underwent remedial surgery for renal PTA failures between 1996 and 2014.
- Analysis of clinical courses and surgical outcomes.
- Specific surgical procedures included reimplantations, bypasses, arterioplasty, and nephrectomies.
Main Results:
- 32 renal arteries in 24 children (mean age 9.3 years) were treated for RVH, primarily ostial stenoses (22 children).
- PTA failures included 27 restenoses and 5 thromboses.
- Surgical management involved various reconstructive techniques and 6 nephrectomies in younger children. Hypertension improved in 54% and was cured in 25% post-surgery, with no perioperative renal failure or mortality.
Conclusions:
- Renal PTA for pediatric RVH, particularly due to ostial disease, can lead to failures.
- Complex remedial surgeries or nephrectomies are sometimes required.
- Nephrectomy is more common in younger children (<10 years).
Background:
Percutaneous transluminal angioplasty (PTA) for the treatment of pediatric renovascular hypertension (RVH) in contemporary practice is accompanied with ill-defined complications. This study examines the mode of pediatric renal PTA failures and the results of their surgical management.
Methods:
Twenty-four children underwent remedial operations at the University of Michigan from 1996 to 2014 for failures of renal PTA. Their clinical courses were retrospectively reviewed and results analyzed.
Results:
Renal PTA of 32 arteries, including 13 with stenting, was performed for severe RVH in 12 boys and 12 girls, having a mean age of 9.3 years. Developmental ostial stenoses affected 22 children. PTA failures included: 27 restenoses and five thromboses. Remedial operations included: 13 renal artery-aortic reimplantations, one segmental renal artery-main renal artery reimplantation, ten aortorenal bypasses, one arterioplasty, one iliorenal bypass, and six nephrectomies for unreconstructable arteries; the latter all in children younger than 10 years. Follow-up averaged 2.1 years. Postoperatively, hypertension was cured, improved, or unchanged in 25, 54, and 21 %, respectively. There was no perioperative renal failure or mortality.
Conclusions:
Renal PTA for the treatment of pediatric RVH due to ostial disease may be complicated by failures requiring complex remedial operations or nephrectomy, the latter usually affecting younger children.
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