Angioplasty for Renal Artery Stenosis in Pediatric Patients: An 11-year Retrospective Experience

Srinivasan, Abhay; Krishnamurthy, G.; Fontalvo-Herazo, Lucia; Nijs, Els; Keller, Marc S.; Meyers, Kevin; Kaplan, Bernard; Cahill, A.

doi:10.1016/j.jvir.2010.07.012

Cited by 72 publications

(58 citation statements)

References 34 publications

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“…Long-term clinical benefit was achieved in 53.3% of our PTA patients, and this rate is consistent with previous reports (55-73%) [10,13,26]. In contrast, the "cure" rate of PTA (13%) was lower in our study than in those reported by other authors, including one report from China (23.1-37%) [10,11,13,26]. We propose that this lower cure rate may be a result of the higher proportion of patients with CVD in our study (40%) compared with previous studies (18-22%) [11,13].…”

Section: Discussionsupporting

confidence: 93%

“…As a result, assessment of PTA by comparing the number of medications used before and after the procedure was not appropriate for the present study. Long-term clinical benefit was achieved in 53.3% of our PTA patients, and this rate is consistent with previous reports (55-73%) [10,13,26]. In contrast, the "cure" rate of PTA (13%) was lower in our study than in those reported by other authors, including one report from China (23.1-37%) [10,11,13,26].…”

Section: Discussionsupporting

confidence: 91%

“…While RVHT is a well-known cause of secondary hypertension in childhood, at the time of referral, many of the affected kidneys were already smaller than normal, implying a delayed diagnosis. In this study, we assessed changes in the size of the affected kidneys over time according to the treatment modality; this approach differentiates our study from previous reports on pediatric RVHT [3,10,11,13,[26][27][28]. Indeed, kidney sizes decreased in some patients over time.…”

Section: Discussionmentioning

confidence: 97%

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Long-Term Outcomes of Pediatric Renovascular Hypertension

Chung

Lee

Park

et al. 2017

Kidney Blood Press Res

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Background/Aims: Renovascular hypertension (RVHT) is an important cause of childhood hypertension. This study evaluated the clinical characteristics and outcomes of Korean children with RVHT. Methods: Children treated for RVHT between 2000 and 2015 at our center were retrospectively reviewed. Results: Forty-six children were followed for a median of 6.5 (0.66-27.23) years. Forty-five percutaneous transluminal angioplasties (PTAs) were performed in 32 children. At the last visit, clinical benefit was observed in 53.3% of children. Patients with comorbid cerebrovascular disease (CVD) showed less favorable long-term outcomes after PTA (clinical benefit in 41.7% vs. 61.1% in others) and higher restenosis rates (50% vs. 31.6% in others). Surgical procedures (bypass or nephrectomy) were performed in 8 patients. After surgery, blood pressure was normalized in 2 patients, improved in 3 patients, and unchanged in the remaining patients. Between PTA group (n=21) and medication group (n=14), percentage of atrophic kidneys became higher after follow-up period in medication group than in PTA group (60.0% vs. 26.1%, P=0.037). Conclusion: Aggressive treatment of pediatric RVHT yielded fair outcomes in our cohort. CVD comorbidity was associated with relatively poor PTA outcomes. To confirm our findings, larger cohort studies with a longer follow-up period are warranted.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 97%

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Long-Term Outcomes of Pediatric Renovascular Hypertension

Chung

Lee

Park

et al. 2017

Kidney Blood Press Res

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“…Our study showed that stenosis length was the most important factor, which was inversely correlated with the effectiveness rate of PTRA. Srinivasan et al (1) found that most pediatric patients with RAS who were cured or improved after a PTRA procedure(s) had lesions less than 10 mm. Tyagi et al (17) found that patients with discrete stenosis (≤10 mm) or residual stenosis (≤20%) had a better blood pressure response.…”

Section: Discussionmentioning

confidence: 99%

Angioplasty for pediatric renovascular hypertension: a 13-year experience

Zhu

He²,

Gu³

et al. 2014

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to evaluate the long-term outcome and efficacy of percutaneous transluminal renal angioplasty (PTRA) for pediatric renal artery stenosis (RAS), which is an important cause of medication-refractory pediatric hypertension. MATERIALS AND METHODSWe retrospectively evaluated 22 hypertensive children (age range, 3-17 years) who underwent PTRA from February 2000 to July 2012. Sixteen patients had Takayasu arteritis and six fibromuscular dysplasia. Five were not included in the statistical analysis due to loss to follow-up. RESULTSTechnical success was achieved in 32 of 34 procedures (94.1%). The stenosis rate decreased from 84.5% before PTRA to 20.1% after PTRA. Treatment was effective in 72.7% (16/22) of patients, including complete cure in 27.3% (6/22) and improvement in 45.5% (10/22). Systolic and diastolic blood pressures decreased from 153±19.1 to 131.7±21.4 mmHg and from 97.9±14.2 to 83.6±19.3 mmHg, respectively (P < 0.01). Number of antihypertensive agents decreased from 2.7 to 0.5 per patient. Restenosis was detected in 40.9% (9/22) of patients, with a restenotic interval of 11.8 months (range, 3-47 months). Lesion length was strongly correlated with clinical success (cure and improvement) (independent-sample t test, P < 0.001; binary logistic regression, P = 0.040). CONCLUSIONLesion length is an important determination of clinical success with PTRA for pediatric RAS. PTRA is an appropriate treatment option for pediatric renovascular hypertension due to Takayasu arteritis and fibromuscular dysplasia.

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“…The imaging should be done in a stepwise fashion. It should consider the need to investigate several vascular beds as a majority of children with RAS display involvement of multiple arteries [3][4][5]. At least 50% of the children have bilateral RAS; some have mainly involvement at the arterial ostium, while others have RAS in smaller intrarenal arteries, both of which can be difficult to diagnose on non-invasive imaging.…”

Section: Which Imaging Technique Should Be Used?mentioning

confidence: 99%

Renal artery stenosis: is angiography still the gold standard in 2011?

Tullus

2011

Pediatr Nephrol

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Renovascular hypertension (RVH) is an unusual cause of hypertension in children that is important to diagnose as it is potentially curable with angioplasty or surgery. Digital subtraction angiography is the gold standard for diagnosing RVH; for other methods like ultrasound, isotope studies, magnetic resonance angiography and computed tomography angiography sensitivity is still too low to reliably exclude RVH. Clinical and laboratory criteria that suggest RVH will be proposed and recommendations when digital subtraction angiography should be performed will be made. A treatment algorithm that suggests when to use medical treatment, interventional radiology and surgery in children with RVH will be given.

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Angioplasty for Renal Artery Stenosis in Pediatric Patients: An 11-year Retrospective Experience

Cited by 72 publications

References 34 publications

Long-Term Outcomes of Pediatric Renovascular Hypertension

Long-Term Outcomes of Pediatric Renovascular Hypertension

Angioplasty for pediatric renovascular hypertension: a 13-year experience

Renal artery stenosis: is angiography still the gold standard in 2011?

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