Percutaneous transluminal angioplasty for renovascular hypertension in children: initial and long-term results
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S Tyagi1, U A Kaul, D K Satsangi
1Department of Cardiology, G.B. Pant Hospital, New Delhi, India.
Insights
Percutaneous transluminal renal angioplasty (PTRA) effectively treats renovascular hypertension in children, significantly lowering blood pressure. This safe procedure is recommended as the primary treatment for pediatric renovascular hypertension.
Area of Science:
- Pediatric Nephrology
- Interventional Cardiology
- Vascular Surgery
Background:
- Renovascular hypertension (RVH) in children is often caused by conditions like aortoarteritis and fibromuscular dysplasia (FMD).
- Severe renal artery stenosis (RAS) in children can lead to significant and difficult-to-manage hypertension.
Purpose of the Study:
- To assess the safety and effectiveness of percutaneous transluminal renal angioplasty (PTRA) for treating severe renal artery stenosis (RAS) in pediatric patients.
- To evaluate the long-term outcomes of PTRA in children with renovascular hypertension.
Main Methods:
- Aortography and PTRA were performed on 35 children (ages 5-14) with severe RAS (>75%).
- The study included patients with unilateral or bilateral RAS, with causes including aortoarteritis and FMD.
- Technical success rates, restenosis, and clinical outcomes including blood pressure changes were monitored.
Main Results:
- PTRA was technically successful in 88.6% of patients and 91.5% of lesions, with significant reduction in RAS.
- Mean systolic blood pressure decreased from 185.1 to 120.6 mm Hg, and diastolic pressure from 118.4 to 84.6 mm Hg post-PTRA.
- 93.1% of patients showed a beneficial blood pressure response, with 58.6% improving and 34.5% cured.
Conclusions:
- Aortoarteritis is the predominant cause of RVH in South Asian children.
- PTRA is a safe and highly effective treatment for pediatric renovascular hypertension.
- PTRA should be considered the treatment of choice for children with renovascular hypertension.
Objective:
To evaluate the efficacy and safety of percutaneous transluminal renal angioplasty (PTRA) in children.
Methods:
We performed aortography and attempted PTRA in 35 consecutive children (age 5 to 14 years, mean 10.8 +/- 2.5 years) with severe hypertension having > or = 75% renal artery stenosis (RAS).
Results:
The stenosis was caused by aortoarteritis in 31 (88.6%) cases and by juvenile idiopathic fibromuscular disease (FMD) in four (11.4%) cases. Twenty-seven (77.1%) patients, including three having RAS of solitary functioning kidney with total occlusion of contralateral renal artery, had bilateral RAS and eight (22.9%) had unilateral RAS. PTRA was technically successful in 54 (91.5%) of 59 stenotic lesions in 31 (88.6%) of 35 patients. Both aortoarteritis and FMD patients had significant decrease in RAS after PTRA. One patient had acute reocclusion of one renal artery after bilateral PTRA, which could be successfully opened by reangioplasty. Postangioplasty angiographic restudy performed in 18 patients at 4 to 72 months (mean 23.1 +/- 27.9 months) after successful angioplasty showed restenosis in 8 (25.8%) of 31 lesions initially dilated and de novo lesions of aorta in two patients. All seven restenotic renal artery lesions attempted and both stenosis of aorta were successfully dilated. Twenty-nine of 31 patients with successful PTRA have been followed up from 4 to 108 months (mean 41.0 +/- 29.3 months). Mean systolic blood pressure decreased from 185.1 +/- 27.4 to 120.6 +/- 19.2 mm Hg and mean diastolic blood pressure decreased from 118.4 +/- 13.2 to 84.6 +/- 10.4 mm Hg after PTRA. Twenty seven (93.1%) of these 29 patients had benefical blood pressure response. Seventeen (58.6%) patients improved, 10 (34.5%) were cured, although 2 (6.9%) patients failed to respond to PTRA. Blood pressure response was better in FMD as compared to aortoarteritis group. Patients with unilateral RAS, discrete stenosis, and post-PTRA stenosis < or = 20% also identified good blood pressure response.
Conclusion:
Aortoarteritis is the most common cause of renovascular hypertension in South Asian children. PTRA is safe and highly effective and therefore should be the treatment of choice in pediatric renovascular hypertension.