Angioplasty for renovascular hypertension in children: 20-year experience.
OBJECTIVE
Our aim was to evaluate the clinical outcomes, safety, and efficacy of percutaneous transluminal angioplasty for renovascular hypertension in children.


METHODS
A retrospective review of data for all children with renovascular hypertension who underwent percutaneous transluminal angioplasty at a single center between 1984 and 2003 was performed. Patients with renal transplants and inflammatory multisystem diseases were excluded.


RESULTS
Thirty-three children, 1.9 to 17.9 years of age (median: 10.3 years), underwent renal angioplasty and/or stenting. Underlying syndromes were present in 10. On angiograms, 16 had bilateral renal artery stenosis, 15 intrarenal disease, 8 aortic stenosis, and 7 cerebrovascular disease. Forty-eight percutaneous transluminal angioplasty procedures were performed, including 15 stenting procedures. There was a high rate of restenosis after stenting (7 of 19 cases, compared with 2 of 27 cases after balloon dilation). Outcomes were cured (ie, blood pressure normal without treatment) for 9 patients, improved blood pressure with same or reduced treatment for 7, blood pressure maintained in >95th percentile because of cerebrovascular disease for 2, no change in blood pressure despite technical success for 10, and technical failure for 5. Blood pressure control improved in 11 of 13 children who had main renal artery disease alone and in 6 of 20 with associated intrarenal disease or stenoses in other vascular beds. There was 1 procedure-related death and 5 minor complications.


CONCLUSIONS
Angioplasty produced clinically worthwhile improvement for approximately 50% of patients. High incidence rates of extrarenal involvement and intrarenal disease and a high restenosis rate after stenting accounted for poor blood pressure control in the rest.
Shroff
Rukshana
R
Department of Nephrourology, Great Ormond Street Hospital for Children, Renal Office, Frontage Building, Great Ormond Street, London WC1N 3JH, United Kingdom.
Roebuck
Derek J
DJ
Gordon
Isky
I
Davies
Roger
R
Stephens
Suzanne
S
Marks
Stephen
S
Chan
Mark
M
Barkovics
Maria
M
McLaren
Clare A
CA
Shah
Vanita
V
Dillon
Michael J
MJ
Tullus
Kjell
K
D000293:Adolescent; D000792:Angiography; D000800:Angioplasty, Balloon; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006978:Hypertension, Renovascular / Q000175:diagnosis / Q000628:therapy*; D007223:Infant; D008297:Male; D012008:Recurrence; D012077:Renal Artery / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome