RENOVASCULAR HYPERTENSION RESULTING FROM NONSPECIFIC AORTOARTERITIS IN CHILDREN - MIDTERM RESULTS OF PERCUTANEOUS TRANSLUMINAL RENAL ANGIOPLASTY AND PREDICTORS OF RESTENOSIS

OBJECTIVE. Nonspecific aortoarteritis is a major cause of renovascular hypertension in children, Stenosis of the renal artery is usually lon g and begins at the origin of that artery We retrospectively studied t he midterm results of angioplasty during treatment and defined the pre dictors of restenosis in 40 stenoses in 24 children. MATERIALS AND MET HODS. All patients had clinically inactive disease and hemodynamically significant stenosis causing hypertension. Midterm results were analy zed by the life table method, The effect of clinical, angiographic, an d technical factors on the restenosis rate was tested by the Kaplan-Me ir survival method. RESULTS. Technical success was obtained without co mplications in 38 (95%) of the lesions in 22 (92%) of the patients. Th e stenosis decreased from 89 +/- 7% to 11 +/- 12%, the pressure gradie nt fell from 97 +/- 27 to 10 +/- 10 mm Hg, and blood pressure decrease d from 174 +/- 14/112 + 11 to 141 +/- 13/88 +/- 11 mm Hg (p <.001). Cl inical benefit was seen in all patients with technically successful an gioplasty. During the follow-up period (33 +/- 22 months), restenosis was seen in eight lesions (20%). The predicted cumulative patency rate at 5 years was 71%. Adverse effects on the rate of restenosis were as sociated with male sex (p =.04), stenosis beginning at the origin of t he renal artery (p =.01), acid more than 20% residual stenosis after a ngioplasty (p =.02). CONCLUSION. Our results show that hypertension in children with renal artery stenosis caused by nonspecific aortoarteri tis can be safely treated by renal angioplasty with excellent midterm results, A long stenosis beginning at the origin of the artery predisp oses to restenosis, but repeat dilatation often produces lasting benef it.