PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY FOR RENOVASCULAR HYPERTENSION IN CHILDREN - INITIAL AND LONG-TERM RESULTS

Objective. To evaluate the efficacy and safety of percutaneous translu minal renal angioplasty (PTRA) in children. Methods. We performed aort ography and attempted PTRA in 35 consecutive children (age 5 to 14 yea rs, mean 10.8 +/- 2.5 years) with severe hypertension having greater t han or equal to 75% renal artery stenosis (RAS). Results. The stenosis was caused by aortoarteritis in 31 (88.6%) cases and by juvenile idio pathic fibromuscular disease (FMD) in four (11.4%) cases. Twenty-seven (77.1%) patients, including three having RAS of solitary functioning kidney with total occlusion of contralateral renal artery, had bilater al RAS and eight (22.9%) had unilateral RAS. PTRA was technically succ essful in 54 (91.5%) of 59 stenotic lesions in 31 (88.6%) of 35 patien ts. Both aortoarteritis and FMD patients had significant decrease in R AS after PTRA. One patient had acute reocclusion of one renal artery a fter bilateral PTRA, which could be successfully opened by reangioplas ty. Postangioplasty angiographic restudy performed in 18 patients at 4 to 72 months (mean 23.1 +/- 27.9 months) after successful angioplasty showed restenosis in 8 (25.8%) of 31 lesions initially dilated and de novo lesions of aorta in two patients. Ail seven restenotic renal art ery lesions attempted and both stenosis of aorta were successfully dil ated. Twenty-nine of 31 patients with successful PTRA have been follow ed up from 4 to 108 months (mean 41.0 +/- 29.3 months). Mean systolic blood pressure decreased from 185.1 +/- 27.4 to 120.6 +/- 19.2 mm Hg a nd mean diastolic blood pressure decreased from 118.4 +/- 13.2 to 84.6 +/- 10.4 mm Kg after PTRA. Twenty seven (93.1%) of these 29 patients had benefical blood pressure response. Seventeen (58.6%) patients impr oved, 10 (34.5%) were cured, although 2 (6.9%) patients failed to resp ond to PTRA. blood pressure response was better in FMD as compared to aortoarteritis group. Patients with unilateral RAS, discrete stenosis, and post-PTRA stenosis less than or equal to 20% also identified good blood pressure response. Conclusion. Aortoarteritis is the most commo n cause of renovascular hypertension in South Asian children. PTRA is safe and highly effective and therefore should be the treatment of cho ice in pediatric renovascular hypertension.