Renovascular hypertension: treatment choices

Over a 10 year period, 17 children received treatment for renovascular hypertension. A stenosis of the main renal artery was demonstrated in 10 patients (bilateral involvement in two) and a branch artery in 7. Fifteen of the 16 patients available for follow up are normotensive after a mean of 3.7 years. The initial treatment choice consisted of nephrectomy (1 patient), partial nephrectomy (1 patient), ligation of a branch artery (1 patient), surgical angioplasty (3 patients), autotransplantation (6 patients), and percutaneous transluminal balloon angioplasty (7 patients). Six patients required secondary surgical procedures (4 nephrectomy, 1 surgical angioplasty and 1 autotransplantation) before the blood pressure was normalised. Transluminal balloon angioplasty was attempted in seven patients but was successful in only two with main renal artery stenoses. Treatment choices have increased for patients with renal artery stenosis lesions and increasing experience and assessment of techniques such as PTA are required.