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Long-term outcome with surgical treatment of renovascular hypertension
1Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN 37232-2730, USA.
Insights
Surgical repair of renovascular lesions in children offers excellent long-term outcomes, with 70% cured and 26% improved, demonstrating the effectiveness of various surgical interventions for renal artery stenosis.
Area of Science:
- Pediatric Surgery
- Vascular Surgery
- Nephrology
Background:
- Renal artery stenosis in children often presents as severe hypertension.
- Fibromuscular hyperplasia is the primary cause, frequently involving the aorta.
- Malignant hypertension and renal failure can be associated complications.
Purpose of the Study:
- To prospectively evaluate surgical approaches for renal artery stenosis in children.
- To assess the long-term outcomes of various treatment strategies.
- To investigate diagnostic and therapeutic interventions for renovascular lesions.
Main Methods:
- Prospective evaluation of 136 children with severe hypertension, identifying 53 with renovascular lesions.
- Utilized aortography for definitive diagnosis and treatment planning.
- Compared surgical techniques including reimplantation, bypass grafting, and nephrectomy.
Main Results:
- Fibromuscular hyperplasia (FMH) was the most common etiology (45/53 patients).
- Surgical revascularization was performed in 38 patients, with high success rates (70% cured, 26% improved) over 16 years.
- Balloon angioplasty showed limited long-term success, primarily in specific locations.
Conclusions:
- Surgical management of pediatric renal artery stenosis yields favorable long-term results.
- Various surgical techniques are effective depending on the specific pathology.
- Early diagnosis and intervention are crucial for managing severe hypertension in children with renovascular disease.
Purpose:
The purpose of this study was to prospectively study certain surgical approaches to renal artery stenosis and the long-term outcomes.
Methods:
One hundred thirty-six children were evaluated for severe hypertension, 53 had renovascular lesions. The approach to diagnosis, the role of balloon angioplasty, comparison of reimplantation with bypass grafting, the role of vein grafts and the incidence of graft aneurysm formation, the possible protective effect of vein graft mesh wraps, and approaches to treatment of associated aortic and visceral artery narrowing were all studied prospectively and the long-term results evaluated.
Results:
Fibromuscular hyperplasia (FMH) was the main etiology (45 of 53 patients), with 17 of these having midaortic involvement as well. Sex distribution was equal; average age was 9 years. Malignant hypertension was the rule, and three had renal failure. Twenty-three of the 45 had bilateral vessel involvement. Fifty of the 53 patients underwent operation. Aortography was the most definitive approach to diagnosis and planning therapy. Balloon angioplasty was used in eight patients, but this only worked long term in branch vessel locations or at graft anastomoses. A variety of surgical approaches were used depending on the pathology encountered. Thirty-eight patients underwent revascularization, seven underwent primary nephrectomy, five underwent primary partial nephrectomy, and 12 had aortoaortic bypass performed. Seventy percent were cured, 26% improved; and 4% did not respond to treatment with up to 16 years of follow-up. There was no mortality.