Pediatric renovascular hypertension: 132 primary and 30 secondary operations in 97 children

James C. Stanley, Enrique Criado, Gilbert R. Upchurch, Patrick D. Brophy, Kyung J. Cho, John E. Rectenwald

Research output: Contribution to journalArticle

84 Citations (Scopus)

Abstract

Purpose: This study was undertaken to characterize the contemporary surgical treatment of pediatric renovascular hypertension. Methods: A retrospective analysis was conducted of the clinical data of 97 consecutive pediatric patients (39 girls, 58 boys), aged from 3 months to 17 years, who underwent operation at the University of Michigan from 1963 to 2006. All but one patient had refractory hypertension not responsive to contemporary medical therapy. Developmental renal artery stenoses accounted for 80% of the renal artery disease, with inflammatory and other ill-defined stenoses encountered less frequently. Splanchnic arterial occlusive lesions affected 24% and abdominal aortic coarctations, 33%. Results: Primary renal artery operations were undertaken 132 times. Procedures included resection beyond the stenosis and implantation into the aorta in 49, renal artery in 7, or superior mesenteric artery in 3; aortorenal and iliorenal bypasses with vein or iliac artery grafts in 40; focal arterioplasty in 10; resection with reanastomosis in 4; operative dilation in 4; splenorenal bypass in 2; and primary nephrectomy in 13 when arterial reconstructions proved impossible. Bilateral renal operations were done in 34 children, and 17 underwent celiac or superior mesenteric arterial reconstructions, including 15 at the time of the renal operation. Thirty patients underwent abdominal aortic reconstructions with patch aortoplasty (n = 19) or thoracoabdominal bypass (n = 11). Twenty-five of the aortic procedures were performed coincidently with the renal operations. Thirty secondary renal artery procedures were done in 19 patients, including nine nephrectomies. Hypertension was cured in 68 children (70%), improved in 26 (27%), and was unchanged in three (3%). Follow-up averaged 4.2 years. No patients required dialysis, and there were no operative deaths. Conclusion: Contemporary surgical treatment of pediatric renovascular hypertension emphasizes direct aortic implantation of the normal renal artery beyond its stenosis and single-staged concomitant splanchnic and aortic reconstructions when necessary. Benefits accompany carefully executed operative procedures in 97% of these children.

Original languageEnglish (US)
Pages (from-to)1219-1228
Number of pages10
JournalJournal of Vascular Surgery
Volume44
Issue number6
DOIs
StatePublished - Dec 1 2006

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Renovascular Hypertension
Renal Artery
Pediatrics
Pathologic Constriction
Viscera
Nephrectomy
Kidney
Hypertension
Renal Artery Obstruction
Aortic Coarctation
Superior Mesenteric Artery
Iliac Artery
Operative Surgical Procedures
Abdomen
Aorta
Dilatation
Dialysis
Veins
Therapeutics
Transplants

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Stanley, J. C., Criado, E., Upchurch, G. R., Brophy, P. D., Cho, K. J., & Rectenwald, J. E. (2006). Pediatric renovascular hypertension: 132 primary and 30 secondary operations in 97 children. Journal of Vascular Surgery, 44(6), 1219-1228. https://doi.org/10.1016/j.jvs.2006.08.009

Pediatric renovascular hypertension : 132 primary and 30 secondary operations in 97 children. / Stanley, James C.; Criado, Enrique; Upchurch, Gilbert R.; Brophy, Patrick D.; Cho, Kyung J.; Rectenwald, John E.

In: Journal of Vascular Surgery, Vol. 44, No. 6, 01.12.2006, p. 1219-1228.

Research output: Contribution to journalArticle

Stanley, JC, Criado, E, Upchurch, GR, Brophy, PD, Cho, KJ & Rectenwald, JE 2006, 'Pediatric renovascular hypertension: 132 primary and 30 secondary operations in 97 children', Journal of Vascular Surgery, vol. 44, no. 6, pp. 1219-1228. https://doi.org/10.1016/j.jvs.2006.08.009
Stanley, James C. ; Criado, Enrique ; Upchurch, Gilbert R. ; Brophy, Patrick D. ; Cho, Kyung J. ; Rectenwald, John E. / Pediatric renovascular hypertension : 132 primary and 30 secondary operations in 97 children. In: Journal of Vascular Surgery. 2006 ; Vol. 44, No. 6. pp. 1219-1228.
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abstract = "Purpose: This study was undertaken to characterize the contemporary surgical treatment of pediatric renovascular hypertension. Methods: A retrospective analysis was conducted of the clinical data of 97 consecutive pediatric patients (39 girls, 58 boys), aged from 3 months to 17 years, who underwent operation at the University of Michigan from 1963 to 2006. All but one patient had refractory hypertension not responsive to contemporary medical therapy. Developmental renal artery stenoses accounted for 80{\%} of the renal artery disease, with inflammatory and other ill-defined stenoses encountered less frequently. Splanchnic arterial occlusive lesions affected 24{\%} and abdominal aortic coarctations, 33{\%}. Results: Primary renal artery operations were undertaken 132 times. Procedures included resection beyond the stenosis and implantation into the aorta in 49, renal artery in 7, or superior mesenteric artery in 3; aortorenal and iliorenal bypasses with vein or iliac artery grafts in 40; focal arterioplasty in 10; resection with reanastomosis in 4; operative dilation in 4; splenorenal bypass in 2; and primary nephrectomy in 13 when arterial reconstructions proved impossible. Bilateral renal operations were done in 34 children, and 17 underwent celiac or superior mesenteric arterial reconstructions, including 15 at the time of the renal operation. Thirty patients underwent abdominal aortic reconstructions with patch aortoplasty (n = 19) or thoracoabdominal bypass (n = 11). Twenty-five of the aortic procedures were performed coincidently with the renal operations. Thirty secondary renal artery procedures were done in 19 patients, including nine nephrectomies. Hypertension was cured in 68 children (70{\%}), improved in 26 (27{\%}), and was unchanged in three (3{\%}). Follow-up averaged 4.2 years. No patients required dialysis, and there were no operative deaths. Conclusion: Contemporary surgical treatment of pediatric renovascular hypertension emphasizes direct aortic implantation of the normal renal artery beyond its stenosis and single-staged concomitant splanchnic and aortic reconstructions when necessary. Benefits accompany carefully executed operative procedures in 97{\%} of these children.",
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