title: Remedial operations for failed endovascular therapy of 32 renal artery stenoses in 24 children.
abstract: BACKGROUND
  Percutaneous transluminal angioplasty (PTA) for the treatment of pediatric renovascular hypertension (RVH) in contemporary practice is accompanied with ill-defined complications. This study examines the mode of pediatric renal PTA failures and the results of their surgical management.
  
  
  METHODS
  Twenty-four children underwent remedial operations at the University of Michigan from 1996 to 2014 for failures of renal PTA. Their clinical courses were retrospectively reviewed and results analyzed.
  
  
  RESULTS
  Renal PTA of 32 arteries, including 13 with stenting, was performed for severe RVH in 12 boys and 12 girls, having a mean age of 9.3 years. Developmental ostial stenoses affected 22 children. PTA failures included: 27 restenoses and five thromboses. Remedial operations included: 13 renal artery-aortic reimplantations, one segmental renal artery-main renal artery reimplantation, ten aortorenal bypasses, one arterioplasty, one iliorenal bypass, and six nephrectomies for unreconstructable arteries; the latter all in children younger than 10 years. Follow-up averaged 2.1 years. Postoperatively, hypertension was cured, improved, or unchanged in 25, 54, and 21 %, respectively. There was no perioperative renal failure or mortality.
  
  
  CONCLUSIONS
  Renal PTA for the treatment of pediatric RVH due to ostial disease may be complicated by failures requiring complex remedial operations or nephrectomy, the latter usually affecting younger children.
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA. jonaelia@med.umich.edu.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Eliason
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Coleman
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Enrique
authors.initials: E
authors.lastname: Criado
authors.affiliation: Section of Pediatric Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Kershaw
authors.affiliation: Section of Pediatric Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Neal B
authors.initials: NB
authors.lastname: Blatt
authors.affiliation: Division of Vascular/Interventional Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Williams
authors.affiliation: Division of Vascular/Interventional Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Narasimham L
authors.initials: NL
authors.lastname: Dasika
authors.affiliation: Division of Vascular/Interventional Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Kyung J
authors.initials: KJ
authors.lastname: Cho
authors.affiliation: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Stanley
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D006978:Hypertension, Renovascular / Q000175:diagnosis / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008824:Michigan; D009392:Nephrectomy / Q000009:adverse effects; D012008:Recurrence; D012078:Renal Artery Obstruction / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D017211:Treatment Failure; D014656:Vascular Surgical Procedures / Q000009:adverse effects
keywords: Arterial restenosis; Children; Percutaneous transluminal angioplasty; Renovascular hypertension