1
|
Guo J, Wu S, Zhang F, Zhang C, Gu Y, Guo L. Long-term outcomes of angioplasty for pediatric renovascular hypertension: A single-center experience. Vascular 2023; 31:122-130. [PMID: 34846234 DOI: 10.1177/17085381211059664] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We used single-center data to evaluate the long-term outcome of percutaneous transluminal angioplasty (PTA) for pediatric renovascular hypertension (RVH) and to analyze the factors that influence effectiveness. METHODS We retrospectively evaluated 33 pediatric RVH patients (18 boys; mean age: 9.1 ± 4 years, range: 2-16) who underwent PTA from January 2007 to December 2019. 15 patients had Takayasu arteritis (TA) and 18 were non-TA. The median follow-up from the initial PTA was 69 months (range: 12-157; IQR: 25.5-89). RESULTS The technical success rate of 52 PTA procedures was 90.4% in 33 children. Renal artery stents were implanted in two patients, external guidewires were used in two patients, and a drug-coated balloon was used in only one patient. The overall effective rate of PTA was 63.6%, including cured 39.4% and improved 24.2%, at the end of follow-up. Overall clinical outcomes were not statistically different between the TA and non-TA groups (p = 0.316), nor were cure rates (p = 0.072). 15 patients received reintervention due to restenosis after the first successful PTA; the interval was 2-56 months (median: 12 months). Four patients received reintervention due to a failed PTA. A total of four patients received open surgery. Binary logistics regression analysis showed that stenosis length and residual stenosis rate were strongly correlated with effective PTA (p = 0.045, p = 0.044). CONCLUSIONS As a primary treatment for pediatric RVH, PTA can achieve satisfactory results, which are influenced by lesion length and residual stenosis rate.
Collapse
Affiliation(s)
- Julong Guo
- Department of Vascular Surgery, 71044Xuanwu Hospital Capital Medical University, Beijing, China
| | - Sensen Wu
- Department of Vascular Surgery, 71044Xuanwu Hospital Capital Medical University, Beijing, China
| | - Fan Zhang
- Department of Vascular Surgery, 71044Xuanwu Hospital Capital Medical University, Beijing, China
| | - Chengchao Zhang
- Department of Vascular Surgery, 71044Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yongquan Gu
- Department of Vascular Surgery, 71044Xuanwu Hospital Capital Medical University, Beijing, China
| | - Lianrui Guo
- Department of Vascular Surgery, 71044Xuanwu Hospital Capital Medical University, Beijing, China
| |
Collapse
|
2
|
Osorio Nader M, Moreno NF, Upton AM, Hernandez JA. Doppler ultrasound for post-angioplasty follow-up in pediatric segmental branch renal artery stenosis: A case report. J Med Imaging Radiat Sci 2022; 53:518-522. [DOI: 10.1016/j.jmir.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/05/2022] [Accepted: 06/22/2022] [Indexed: 11/28/2022]
|
3
|
Eun Y, Kim JH, Lim SH, Ahn YH, Kang HG, Ha IS. Two cases of children presenting with polydipsia, polyuria, and malignant hypertension: Answers. Pediatr Nephrol 2022; 37:559-561. [PMID: 34727244 DOI: 10.1007/s00467-021-05236-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Yong Eun
- Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Ji Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seon Hee Lim
- Department of Pediatrics, Uijeongbu Eulji Medical Center, Uijeongbu-si, Republic of Korea
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea
| | - Il-Soo Ha
- Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
4
|
Boggs HK, Kiang SC, Magtanong E, Pop A, Abou-Zamzam AM, Tomihama RT. Pediatric Renal Artery Stenosis: A 19 Year Experience in Management And Outcomes At A Tertiary Pediatric Hospital. Ann Vasc Surg 2022; 83:35-41. [DOI: 10.1016/j.avsg.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 01/14/2022] [Accepted: 02/02/2022] [Indexed: 11/01/2022]
|
5
|
Zhao L, Zhao X, Hu X, Yang H, Wu L. Mid-term outcome of angioplasty for pediatric renovascular hypertension. J Vasc Interv Radiol 2021; 33:399-407. [PMID: 34896573 DOI: 10.1016/j.jvir.2021.10.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To evaluate the mid-term outcome of percutaneous transluminal renal angioplasty (PTRA) for pediatric renovascular hypertension (RVH). MATERIALS AND METHODS The clinical data of patients who underwent PTRA for RVH in our hospital from 2012 to 2019 were analyzed retrospectively. Post-procedural blood pressure, glomerular filtration rate (GFR) of the affected kidney, restenosis and complications were closely followed up. RESULTS The procedure of PTRA was performed in total of 30 children (20 males and 10 females), with a mean age of 7.32±0.74 years (40 days ∼13.92 years) and a mean weight of 24.99±2.26 kg (3.4 ∼ 53kg). The median follow-up period was 26.5 months (1 month ∼7.5 years). Technical success was achieved in 26 of 30 patients (86.7%). Three patients (10.0%) developed restenosis. Only 1 patient underwent stent implantation, and the stent fractured 8 months later, requiring further intervention. No other complication was found. In terms of clinical benefit of blood pressure control after the initial PTRA procedure, 15 patients (50%) were cured and 7 (23.3%) improved. There was no significant difference in etiology, lesion location and length between patients with clinical benefit and failure (p=0.06, 0.202 and 0.06). The GFR of the affected kidney was significantly improved from 19.85±11.24 (ml/min) to 38.09±11.88 (ml/min) at 6 months follow-up after PTRA (p<0.001). CONCLUSION The overall results of PTRA for pediatric RVH caused by different etiologies are promising. Not only does it provide clinical benefit of blood pressure control in 73.3% of patients, it also significantly improves the function of the affected kidney.
Collapse
Affiliation(s)
- Lu Zhao
- Cardiovascular center, Children's Hospital of Fudan University, Shanghai, P.R China, 201102
| | - Xin Zhao
- Cardiovascular center, Children's Hospital of Fudan University, Shanghai, P.R China, 201102
| | - Xihong Hu
- Department of Radiology, Children's Hospital of Fudan University, Shanghai, P.R China, 201102
| | - Haosheng Yang
- The Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA, 10029
| | - Lin Wu
- Cardiovascular center, Children's Hospital of Fudan University, Shanghai, P.R China, 201102.
| |
Collapse
|
6
|
Renovascular hypertension in pediatric patients: update on diagnosis and management. Pediatr Nephrol 2021; 36:3853-3868. [PMID: 33851262 DOI: 10.1007/s00467-021-05063-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 01/03/2023]
Abstract
Renovascular hypertension (RVH) is defined as an elevated blood pressure caused by kidney hypoperfusion, generally as a result of anatomic stenosis of the renal artery with consequent activation of the Renin Angiotensin-Aldosterone System. The main causes include genetic and inflammatory disorders, extrinsic compression, and idiopathic alterations. RVH is often asymptomatic and should be suspected in any child with refractory hypertension, especially if other suggestive findings are present, including those with severe hypertension, abdominal bruit, and abrupt fall of glomerular filtration rate after administration of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers. There is a consensus that digital subtraction angiography is the gold standard method for the diagnosis of RVH. Nevertheless, the role of non-invasive imaging studies such as Doppler ultrasound, magnetic resonance angiography, or computed tomographic angiography remains controversial, especially due to limited pediatric evidence. The therapeutic approach should be individualized, and management options include non-surgical pharmacological therapy and revascularization with percutaneous transluminal renal angioplasty (PTRA) or surgery. The prognosis is related to the procedure performed, and PTRA has a higher restenosis rate compared to surgery, although a decreased risk of complications. This review summarizes the causes, physiopathology, diagnosis, treatment, and prognosis of RVH in pediatric patients. Further studies are required to define the best approach for RVH in children.
Collapse
|
7
|
Coleman DM, Eliason JL, Beaulieu R, Jackson T, Karmakar M, Kershaw DB, Modi ZJ, Ganesh SK, Khaja MS, Williams D, Stanley JC. Surgical management of pediatric renin-mediated hypertension secondary to renal artery occlusive disease and abdominal aortic coarctation. J Vasc Surg 2020; 72:2035-2046.e1. [PMID: 32276020 DOI: 10.1016/j.jvs.2020.02.045] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/15/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Renovascular hypertension (RVH) associated with renal artery and abdominal aortic narrowings is the third most common cause of pediatric hypertension. Untreated children may experience major cardiopulmonary complications, stroke, renal failure, and death. The impetus of this study was to describe the increasingly complex surgical practice for such patients with an emphasis on anatomic phenotype and contemporary outcomes after surgical management as a means of identifying those factors responsible for persistent or recurrent hypertension necessitating reoperation. METHODS A retrospective analysis was performed of consecutive pediatric patients with RVH undergoing open surgical procedures at the University of Michigan from 1991 to 2017. Anatomic phenotype and patient risk factors were analyzed to predict outcomes of blood pressure control and the need for secondary operations using ordered and binomial logistic multinomial regression models, respectively. RESULTS There were 169 children (76 girls, 93 boys) who underwent primary index operations at a median age of 8.3 years; 31 children (18%) had neurofibromatosis type 1, 76 (45%) had abdominal aortic coarctations, and 28 (17%) had a single functioning kidney. Before treatment at the University of Michigan, 51 children experienced failed previous open operations (15) or endovascular interventions (36) for RVH at other institutions. Primary surgical interventions (342) included main renal artery (136) and segmental renal artery (10) aortic reimplantation, renal artery bypass (55), segmental renal artery embolization (10), renal artery patch angioplasty (8), resection with reanastomosis (4), and partial or total nephrectomy (25). Non-renal artery procedures included patch aortoplasty (32), aortoaortic bypass (32), and splanchnic arterial revascularization (30). Nine patients required reoperation in the early postoperative period. During a mean follow-up of 49 months, secondary interventions were required in 35 children (21%), including both open surgical (37) and endovascular (14) interventions. Remedial intervention to preserve primary renal artery patency or a nephrectomy if such was impossible was required in 22 children (13%). The remaining secondary procedures were performed to treat previously untreated disease that became clinically evident during follow-up. Age at operation and abdominal aortic coarctation were independent predictors for reoperation. The overall experience revealed hypertension to be cured in 74 children (44%), improved in 78 (46%), and unchanged in 17 (10%). Children undergoing remedial operations were less likely (33%) to be cured of hypertension. There was no perioperative death or renal insufficiency requiring dialysis after either primary or secondary interventions. CONCLUSIONS Contemporary surgical treatment of pediatric RVH provides a sustainable overall benefit to 90% of children. Interventions in the very young (<3 years) and concurrent abdominal aortic coarctation increase the likelihood of reoperation. Patients undergoing remedial surgery after earlier operative failures are less likely to be cured of hypertension. Judicious postoperative surveillance is imperative in children surgically treated for RVH.
Collapse
Affiliation(s)
- Dawn M Coleman
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich.
| | - Jonathan L Eliason
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Robert Beaulieu
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Tatum Jackson
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Monita Karmakar
- Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - David B Kershaw
- Division of Pediatric Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Mich
| | - Zubin J Modi
- Division of Pediatric Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Mich; Susan B. Meister Child Evaluation and Research Center, University of Michigan, Ann Arbor, Mich
| | - Santhi K Ganesh
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Mich; Department of Human Genetics, University of Michigan, Ann Arbor, Mich
| | - Minhaj S Khaja
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan, Ann Arbor, Mich
| | - David Williams
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan, Ann Arbor, Mich
| | - James C Stanley
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich
| | | |
Collapse
|