The surgical management of renovascular hypertension in children and youngadults

Objectives: to assess the outcome and durability of operative revascularisa tion in young patients with renovascular hypertension. Design: retrospective study. Methods: the records of all young patients (under 25 years) operated on for renovascular hypertension at St Mary's Hospital 1988-1998 were reviewed. W e assessed the aetiology of hypertension, operations performed, effect of t reatment on blood pressure, renal function and requirement for antihyperten sive medication during follow-up. Results: ten patients were identified who had been considered for surgery, of median age 16 years (22 months to 22 years). Fibromuscular dysplasia was present in five patients, mid-aortic syndrome (MAS) in four and neurofibro matosis in one. Operations performed were aortorenal bypass (three), aorto- aortic bypass +/- renal bypass (three), splenorenal bypass (one) and autotr ansplantation (one). Of the three patients treated by balloon angioplasty, only one had a successful result. One patient with MAS is currently awaitin g surgery. Over a median follow-up of 24 months (8-144), seven patients are normotensi ve off all antihypertensive medication. Of two patients on reduced doses of medication, one (splenorenal bypass) required surgical repair of a late (9 years) coeliac stenosis. Conclusions: The surgical treatment of renovascular hypertension in careful ly selected young patients gives durable results. Blood pressure is well co ntrolled long-term, and the need for antihypertensive medication is removed altogether in the majority of patients.