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J Pediatr Surg. 2018 Sep;53(9):1825-1831. doi: 10.1016/j.jpedsurg.2017.12.008. Epub 2017 Dec 24.

The management of pediatric renovascular hypertension: a single center experience and review of the literature.

Author information

1
Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
2
Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
3
Division of Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
4
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
5
Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: Jaimie.Nathan@cchmc.org.

Abstract

INTRODUCTION:

Renal artery occlusive disease is poorly characterized in children; treatments include medications, endovascular techniques, and surgery. We aimed to describe the course of renovascular hypertension (RVH), its treatments and outcomes.

METHODS:

We performed literature review and retrospective review (1993-2014) of children with renovascular hypertension at our institution. Response to treatment was defined by National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents at most-recent follow-up.

RESULTS:

We identified 39 patients with RVH. 54% (n=21) were male, with mean age of 6.93 ± 5.27 years. Most underwent endovascular treatment (n=17), with medication alone (n=12) and surgery (n=10) less commonly utilized. Endovascular treatment resulted in 18% cure, 65% improvement and 18% failure; surgery resulted in 30% cure, 50% improvement and 20% failure. Medication alone resulted in 0% cure, 75% improvement and 25% failure. 24% with endovascular treatment required secondary endovascular intervention; 18% required secondary surgery. 20% of patients who underwent initial surgery required reoperation for re-stenosis. Mean follow-up was 52.2 ± 58.4 months.

CONCLUSIONS:

RVH treatment in children includes medications, surgical or endovascular approaches, with all resulting in combined 79% improvement in or cure rates. A multidisciplinary approach and individualized patient management are critical to optimize outcomes.

TYPE OF STUDY:

Retrospective comparative study LEVEL OF EVIDENCE: Level III.

KEYWORDS:

Fibromuscular dysplasia; Hypertension; Midaortic syndrome; Pediatric hypertension; Renal artery stenosis; Renovascular hypertension

PMID:
29397961
DOI:
10.1016/j.jpedsurg.2017.12.008
[Indexed for MEDLINE]

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