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Percutaneous transluminal angioplasty for renovascular hypertension in children
R L Chevalier1, C J Tegtmeyer, R A Gomez
1Department of Pediatrics, University of Virginia, School of Medicine, Charlottesville 22908.
Insights
Percutaneous transluminal angioplasty (PTA) offers a promising alternative to surgery for renovascular hypertension in children. PTA is highly effective for fibromuscular dysplasia and shows potential for transplant renal artery stenosis.
Area of Science:
- Pediatric Nephrology
- Interventional Cardiology
- Vascular Surgery
Background:
- Renovascular hypertension in children presents a significant clinical challenge.
- Reconstructive surgery has historically been the primary treatment modality.
- Percutaneous transluminal angioplasty (PTA) has emerged as a less invasive alternative.
Observation:
- This review analyzes 37 pediatric cases of renal artery stenosis treated with PTA.
- Patient age ranged from 1.3 to 17 years (mean 10 years).
- Etiologies included fibromuscular dysplasia, unspecified unilateral/bilateral stenosis, neurofibromatosis, renal transplant, atherosclerosis, and postsurgical stenosis.
Findings:
- PTA achieved a cure in 90% (9/10) of patients with fibromuscular dysplasia.
- 3 of 4 patients with renal transplant arterial stenosis experienced cure or improvement.
- Overall, 11 PTA failures were noted, including all neurofibromatosis cases.
Implications:
- PTA is the preferred treatment for pediatric hypertension secondary to fibromuscular dysplasia.
- PTA should be considered for stenosis of transplanted renal arteries.
- Treatment for other causes of renal artery stenosis requires individualized assessment.
Abstract:
Percutaneous transluminal angioplasty (PTA) has been developed over the past 8 years as an alternative to reconstructive surgery for renovascular hypertension. We report three cases and review the use of PTA in children with renal artery stenosis. At least 37 cases of PTA have been reported in patients whose ages ranged from 1.3 to 17 years (mean 10 years). Of these, 10 had fibromuscular dysplasia; 13 unspecified unilateral renal artery stenosis; 4 bilateral stenosis; 4 neurofibromatosis; 4 renal transplant; 1 atherosclerosis; and 1 postsurgical stenosis. Nine of 10 patients with fibromuscular dysplasia were cured and 3 of 4 with renal transplant arterial stenosis were cured or improved. There were 11 failures of PTA, including all 4 patients with neurofibromatosis and 1 with transplant arterial stenosis. We conclude that PTA is the treatment of choice for children with hypertension due to fibromuscular dysplasia and should be attempted for stenosis of the transplanted renal artery. Other lesions resulting in renal artery stenosis may not be as amenable to dilation and should be considered on an individual basis.