Endovascular recanalization for pediatric hypertension secondary to total renal artery occlusion.

Abstract

Purpose

To assess the feasibility and efficacy of percutaneous transluminal renal angioplasty (PTRA) for pediatric renovascular hypertension (RVH) secondary to total renal artery occlusion (RAO).

Methods

From 2011 to 2021, 13 pediatric patients with RVH confirmed with 14 occluded renal artery lesions were reviewed. The mean age was11.2 years (range 4 to 16). Nine lesions involved main artery occlusion, while five lesions featured branch occlusion. Blood Pressure Ratio (BPR) was defined as the ratio of the actual BP value to the 95th percentile value adjusted for age, gender, and height.

Results

PTRA was performed on nine patients (9/13, 69%). Technical success was achieved in five patients (5/9, 56%), with stent placement in two children (2/9, 22%). During the 12-month follow-up, restenosis was identified in two stent-receiving patients at the 12-month follow-up visit (2/9, 22%). Mean systolic BPR decreased from 1.20 ± 0.07 to 0.96 ± 0.06 (p = 0.003), mean diastolic BPR decreased from 1.19 ± 0.07 to 0.95±0.08 (p = 0.005) and the number of required medications decreased from 3.8 ± 0.8 to 2.4 ± 0.9 (p = 0.052) following PTRA. Subsequent to PTRA, the mean GFR of the occluded kidney improved from 19.5 ± 12.3 mL/ min to 36.3 ± 10.8 mL/ min (p = 0.007) and the mean longitudinal dimension of the affected kidneys significantly increased from 8.2 ± 1.5 cm to 9.2 ± 1.7 cm (p = 0.006).

Conclusions

Endovascular treatment is feasible for pediatric RAO, results in acceptable BP control and preserves renal function.