Angioplasty for renal artery stenosis in pediatric patients: an 11-year retrospective experience.
OBJECTIVE
Studies of long-term percutaneous transluminal angioplasty (PTA) results have been less extensive in children than in adults. The authors sought to evaluate the outcomes of PTA for pediatric renovascular hypertension.


METHODS
The authors retrospectively evaluated 19 hypertensive children (ages 2-18 years) who underwent renal PTA from 1997-2009. Angiograms were reviewed in consensus to characterize lesions. This information was correlated with data from chart review to determine clinical outcomes.


RESULTS
Seven patients had neurofibromatosis type 1 (NF1), and 12 had fibromuscular dysplasia (FMD); one was lost to follow-up. Technical success was achieved in 29 of 32 lesions (91%). Cure of hypertension was achieved in seven of 18 patients (39%) and improvement in three (17%). There was a failed hypertension response in eight (44%): two with refractory stenosis, four with recurrent stenosis, and two with no response despite technical success. PTA was repeated in five children, all with failed response. Cure or improvement was seen in five of seven patients with NF1 and five of 11 with FMD. Most (nine of ten) patients with cure/improvement had single lesions or discrete lesions ≤ 10 mm. Residual stenosis < 10% was associated with cure/improvement (P = .0395). Three of five with bilateral and two of two with intraparenchymal disease demonstrated failure. The percentage of initial stenosis and presence of ostial lesions, aneurysms, or collaterals were not predictive of clinical response to PTA (P > .05). Cutting balloons were used after failure to efface with conventional balloons in seven patients and was successful in five of seven.


CONCLUSIONS
Despite a high rate of technical success, PTA provided a clinical benefit in a smaller majority of children. This study characterizes the utility of pediatric renal angioplasty and suggests criteria that may be prognostic of patient response.
Srinivasan
Abhay
A
Department of Radiology, The Children's Hospital of Philadelphia, 34(th) Street at Civic Center Boulevard, Philadelphia, PA 19104, USA. bishopfinn@hotmail.com
Krishnamurthy
Ganesh
G
Fontalvo-Herazo
Lucia
L
Nijs
Els
E
Keller
Marc S
MS
Meyers
Kevin
K
Kaplan
Bernard
B
Cahill
Anne-Marie
AM
D000293:Adolescent; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008297:Male; D009456:Neurofibromatosis 1 / Q000150:complications* / Q000000981:diagnostic imaging; D016518:Neurofibromatosis 2 / Q000150:complications* / Q000000981:diagnostic imaging; D018579:Patient Selection; D015143:Philadelphia; D011859:Radiography; D012008:Recurrence; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D017211:Treatment Failure
D000959:Antihypertensive Agents