Interventions in children with renovascular hypertension: A 27-year retrospective single-center experience

Hitesh Agrawal; Douglas Moodie; Athar M Qureshi; Alisa A Acosta; Jose A Hernandez; Michael C Braun; Henri Justino

doi:10.1111/chd.12608

Interventions in children with renovascular hypertension: A 27-year retrospective single-center experience

Congenit Heart Dis. 2018 May;13(3):349-356. doi: 10.1111/chd.12608. Epub 2018 Apr 10.

Authors

Hitesh Agrawal^{1

2}, Douglas Moodie¹, Athar M Qureshi^{1

2}, Alisa A Acosta³, Jose A Hernandez⁴, Michael C Braun³, Henri Justino^{1

2}

Affiliations

¹ Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Lillie Frank Abercrombie Section of Cardiology, Houston, Texas.
² Texas Children's Hospital and Baylor College of Medicine, C. E. Mullins Cardiac Catheterization Laboratories, Houston, Texas.
³ Renal Section, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas.
⁴ Interventional Radiology Section, Pediatric Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas.

PMID: 29635838
DOI: 10.1111/chd.12608

Abstract

Background: Renovascular hypertension (RVH) can be caused by renal artery stenosis (RAS) and/or middle aortic syndrome (MAS).

Methods: Patients who received surgical or transcatheter treatment for RVH between 1/1991 and 11/2017 were retrospectively reviewed using age = adjusted blood pressure ratio (BPR).

Results: Fifty-three patients diagnosed with RVH at a median age of 4.5 (0-18) years were included. Vascular involvement ranged from MAS with RAS (20), RAS only (32), and MAS only (1). The first intervention was transcatheter in 47 patients (transcatheter group: angioplasty = 41, stenting = 5, and thrombectomy = 1), and surgical in 6 patients (surgical group), occurring at a median age of 6.2 (0.1-19.6) years. There was a change toward transcatheter interventions as the first procedure over the study period. First reinterventions in the transcatheter group (27 lesions in 18 patients) were repeat transcatheter (in 20 lesions) and surgery (7 lesions) at a median of 92 (2-2555) days; in the surgical group (5 lesions in 4 patients) first reinterventions were transcatheter (4 lesions) and repeat surgery (1) at a median of 2.2 (1.1-12.0) years. A total of 136 transcatheter and 30 surgical discrete interventions were performed. There was a significant decline in antihypertensive medications and BPR at 4-6 months after the first intervention and on last follow-up in patients initially treated by transcatheter means while the decline was not significant in the surgical group (limited by small sample size). Complications were significantly more common in the surgical group (P < .01), 11/27 (41%) vs 10/136 (7.4%). Four patients died (2 from each group): 2 with congenital renal artery atresia and MAS, 2 with MAS and RAS. The median follow-up interval was 3.6 (0.1-35.2) years.

Conclusion: Pediatric patients with RVH treated with transcatheter means as the first intervention had significant improvement in BPR, as well as decline in antihypertensive medications and were less likely to suffer major complications.

Keywords: midaortic syndrome; middle aortic syndrome; renal artery stenosis; renovascular hypertension.

Publication types

Review

MeSH terms

Child
Endovascular Procedures / methods*
Forecasting*
Humans
Hypertension, Renovascular / etiology
Hypertension, Renovascular / surgery*
Renal Artery Obstruction / complications
Renal Artery Obstruction / surgery*
Retrospective Studies