title: Early and long-term results after reconstructive surgery in 42 children and two young adults with renovascular hypertension due to fibromuscular dysplasia and middle aortic syndrome.
abstract: OBJECTIVE
  This retrospective study presents the early and late results of pediatric patients who underwent reconstructive surgery for renovascular hypertension (RVH) between 1979 and 2009.
  
  
  METHODS
  From 1979 to 2009 44 patients (male 22; mean age 13±5.2 years, range 1-19 years; early childhood 7 [1-6 years], middle childhood 5 [7-10 years]; adolescents 32 [11-19 years]) with renovascular hypertension underwent surgery for abdominal aortic stenoses (n=6), renal artery stenosis (RAS) (n=25) or for combined lesions (n=13). Nineteen aortic stenoses (bypass/interposition 10/5, patch dilatation/thromboendarterectomy 2/2), 51 renal arteries (interposition 36, resection+reimplantation 13, patch dilatation/aneurysmorraphy 1 each), and 10 visceral arteries (resection+reimplantation 6, interposition 3, patch dilatation 1) were reconstructed. Each patient underwent duplex studies and if required intra-arterial digital subtraction angiography. Reoperations within 30 postoperative days were required in four (9%) of the patients for occlusion of four arteries (6%), achieving a combined technical success rate of 94%.
  
  
  RESULTS
  After 114±81 months 36 patients were re-examined by duplex and magnetic resonance angiography (2 not surgery-related deaths 7/12 years postoperatively, 8 patients lived abroad). Twelve patients had required a second and three a third procedure. Hypertension was cured early/late postoperatively in 27%/56%, improved in 41%/44%, and remained unchanged in 32%/0%. Best late results were obtained in patients with isolated aortic disease and at the age of middle childhood.
  
  
  CONCLUSIONS
  Reconstructive surgery for pediatric RVH yields good results at every age and every type of lesion. However, these children should be followed up closely and to avoid early cardiovascular disease and death in later life, surgery should not be delayed.
authors.affiliation: Hospital Ev. Klinikum Niederrhein, Duisburg, Germany; Department of Vascular Surgery and Kidney Transplantation, Heinrich-Heine-University Hospital, Dusseldorf, Germany. Electronic address: wilhelm.sandmann@evkln.de.
authors.forename: W
authors.initials: W
authors.lastname: Sandmann
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital, Dusseldorf, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Dueppers
authors.affiliation: Department of Vascular Surgery and Kidney Transplantation, Heinrich-Heine-University Hospital, Dusseldorf, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Pourhassan
authors.affiliation: Renal Division, Brigham and Women's Hospital Boston, MA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Voiculescu
authors.affiliation: Department of Radiology, Heinrich-Heine-University Hospital, Dusseldorf, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Klee
authors.affiliation: Department of Vascular Surgery and Kidney Transplantation, Heinrich-Heine-University Hospital, Dusseldorf, Germany.
authors.forename: K M
authors.initials: KM
authors.lastname: Balzer
mesh_terms: D000293:Adolescent; D015901:Angiography, Digital Subtraction; D001018:Aortic Diseases / Q000150:complications* / Q000175:diagnosis; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005352:Fibromuscular Dysplasia / Q000150:complications* / Q000175:diagnosis; D005500:Follow-Up Studies; D006801:Humans; D006978:Hypertension, Renovascular / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D007223:Infant; D018810:Magnetic Resonance Angiography; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012077:Renal Artery / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D055815:Young Adult
keywords: Children; Pediatric vascular surgery; Renovascular hypertension; Stenosis