Renal Artery Intervention In Pediatric And Adolescent Patients: A Twenty-Year Experience

Ying Huang, MD, Audra A. Noel, MD, Dawn S. Milliner, MD, Thomas C. Bower, MD, Manju Kalra, MD,  Timothy M. Sullivan, MD, Peter Gloviczki, MD, Michael A. McKusick, MD and Tanya L. Hoskin
Division of Vascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN

Objectives: At least 3-10% of children and adolescents with hypertension have renal artery (RA) disease, yet the role of endovascular therapy in this population is unknown.
Methods: Data of ≤ 21 year-old patients with renal hypertension between 1986-2005 were retrospectively reviewed. Kaplan Meier estimation, log-rank tests, and Cox proportional hazards regression were analyzed.
Results: Of 196 children with renal hypertension, 33(17%) had RA disease, and 22(11%) underwent RA revascularization. Twelve girls and ten boys (mean 14.7 years, 3-21) were treated for fibromuscular dysplasia (77%, 17/22) and arteritis (23%, 5/22). Fourteen (64%) had unilateral, eight (36%) had bilateral RA disease; nine (41%) had concomitant aortic anomalies. Twenty-two patients were treated for 28 lesions; 23 were treated open and five with balloon angioplasty. Open surgery included 21 aorto-renal bypasses, 1 patch angioplasty, and 1 spleno-renal reimplantation, with concomitant aortoplasty in four. The 21 bypass conduits included 13 saphenous veins, two hypogastric arteries, one vein-artery composite, and five prosthetic. Endovascular patients had shorter hospital and ICU stays than open procedures (1±0.4 vs. 8±4day, P=.0003, 0 vs. 2±1day). Early morbidity was 17%(4/23), all in open surgery. No deaths occurred Intervention benefited 21(96%) patients; hypertension was cured in 15(68%), improved in 6(27%), and unchanged in one(5%). At mean follow-up of 4.6 years (30days-14.5years) for open and 1.7 years (30days-6.6years) for endovascular, 100%(5/5) of the endovascular patients were cured, vs. 56%(10/18) of open (P=.122).
Conclusions: Both surgical and endovascular management benefits pediatric patients with RA hypertension. Endovascular therapy appears promising as first line treatment.