[Role of surgery in the treatment of renovascular hypertension in the child]

Abstract

The aim of this retrospective study was to report our experience of the surgical treatment of renovascular hypertension in children and to define the role of surgery in the treatment of this form of hypertension. The author's series included 83 patients (49 girls, 34 boys), 28 months to 18 years of age (mean: 10.3) operated on from 1970 to 2001. All patients had elevated blood pressure and underwent the investigations usually performed in patients with hypertension. Lesions were bilateral in 28 cases. The operation was decided after failure of percutaneous angioplasty in the patients treated since 1982. Due to bilateral procedures and to secondary or late re-operations, the number of surgical procedures was 114 (15 nephrectomies and 99 arterial repairs). The repairs were performed by extracorporeal surgery in 25 cases and by conventional in situ surgery in 74 cases. Whenever an arterial substitute was necessary, an arterial autograft was preferred since this material does not undergo late degenerative changes with time. Fibrodysplasia of the renal artery was the prevailing pathologic finding (70%). Associated lesions were observed in 59% of the patients: coarctation of the abdominal aorta (23 patients), stenoses, obstructions or aneurysms of splanchnic arteries (23 lesions in 17 patients), pheochromocytoma (2 patients), arterial lesions of distant arterial territories in patients with Takayasu's aortitis (7 patients). There was no postoperative death in this series. Seven postoperative thromboses occurred (7% of the repairs). In the long-term follow-up, three recurrent stenoses and two aneurysms of a venous autograft were repaired surgically. In two patients, a stenosis of the opposite artery occurred and was also repaired. In two patients, a stenosis of the abdominal aorta worsened and required an aortic by-pass 3 and 12 years after the renal artery repair. In patients with Takayasu's disease, operations in other arterial territories (supra-aortic trunks, coronary arteries) were required in two patients. The complete cure of arterial hypertension was obtained in 82% of the patients. In young children, growth of the repairs was normal when age increased. Surgery still keeps a major place in the treatment of renovascular hypertension in children. Its prognosis is favourable since atheroma, visceral or renal lesions are usually lacking.