Primer on Renovascular Hypertension in Children: Focus on Endovascular Intervention

Pediatric renovascular hypertension (RVHTN) results from flow-limiting disease of the renal arterial vasculature and is a potentially treatable cause of pediatric hypertension. Causes of pediatric RVHTN include idiopathic causes, fibromuscular dysplasia, neurofibromatosis, vasculitis, traumatic vascular injury, aneurysms, and aberrant renal arterial supply. Diagnostic imaging allows screening for and confirmation of pediatric RVHTN. Renal sonography with Doppler evaluation is the initial test of choice, followed by CT angiography and MR angiography. However, these modalities may not demonstrate intrarenal segmental or subsegmental branch disease. Therefore, conventional angiography maintains a significant role in diagnosis of pediatric RVHTN. Once diagnosed, pediatric RVHTN is initially treated with antihypertensive medications. Minimally invasive procedures, including angioplasty and embolization, may temporize or cure RVHTN. Surgical intervention-including renal artery reconstruction or reimplantation, aortorenal bypass grafting, or even nephrectomy-may be required for flow-limiting pathologic conditions, which often require endovascular strategies for maintenance. Renal artery stent placement is generally avoided due to limited data and risk of occlusion, although it can be considered in cases of iatrogenic dissection or severe elastic recoil refractory to angioplasty. Having appropriately sized covered stent-grafts nearby as a safety precaution is encouraged when performing these interventions. Radiologists play an invaluable role in the care of patients with pediatric RVHTN through multimodality diagnostic tools, both noninvasive and minimally invasive. The authors review medical management, diagnostic imaging, and endovascular interventions involved in caring for patients with pediatric RVHTN, to optimize diagnostic and interventional radiologist participation in multidisciplinary care with pediatric nephrologists and vascular surgeons. ^©RSNA, 2025 Supplemental material is available for this article.