The management of pediatric renovascular hypertension: a single center experience and review of the literature
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In brief
In brief
Retrospective study of 39 pediatric patients with renovascular hypertension treated over 21 years comparing medical management, endovascular intervention, and surgical approaches. Combined cure and improvement rates reached 79% across all modalities, with endovascular treatment most commonly used but requiring secondary interventions in 42% of cases.
Written by the GCMD Library team from the article.
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