Results of surgical treatment for renovascular hypertension in children

30 year single centre experience

Marike B. Stadermann, Giovanni Montini, George Hamilton, Derek J. Roebuck, Clare A. McLaren, Michael J. Dillon, Stephen D. Marks, Kjell Tullus

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background. We retrospectively reviewed the medical records of all patients who underwent surgery as part of the treatment of renovascular hypertension (RVH) at our centre between 1979 and 2008.Patients. Thirty-seven children (65% male) with a median age of 7.6 (0.4-17.9) years were identified with a median systolic blood pressure (SBP) of 140 (105-300) mm Hg prior to surgery. Bilateral renal artery stenosis and intra-renal disease were present in 19 (51%) patients, mid-aortic syndrome in 15 (40%), involvement of visceral arteries in eight out of 35 (23%) and coexisting cerebral disease in eight out of 30 (26%) investigated patients.Results. Surgical procedures (n = 53) included (i) nephrectomy (18, of which two unplanned and two secondary due to technical failure), (ii) renovascular surgery on the renal arteries (28, of which 18 had autologous surgery and 10 synthetic grafts inserted for revascularisation) and (iii) aortic reconstruction with (6) and without (1) a synthetic graft. Post-operative complications were haemorrhage (5), septicaemia (5) and chylous ascites (1). There were no perioperative deaths; two children died during follow-up. The SBP post-surgery improved to a median value of 116 (range 90-160) mm Hg. Twelve months after surgery, 16 (43%) children had normal blood pressure without treatment, 15 (41%) normal or improved on one to four antihypertensive drugs and four (11%) unchanged; no data were available for two (5%) children.Conclusion. Surgery effectively treated the hypertension of 90% of our children, when performed in conjunction with medical therapy and interventional radiology. In spite of aggressive surgical treatment, RVH is sometimes a progressive disease.

Original languageEnglish
Pages (from-to)807-813
Number of pages7
JournalNephrology Dialysis Transplantation
Volume25
Issue number3
DOIs
Publication statusPublished - Mar 2010

Fingerprint

Renovascular Hypertension
Blood Pressure
Therapeutics
Chylous Ascites
Transplants
Interventional Radiology
Renal Artery Obstruction
Renal Artery
Nephrectomy
Antihypertensive Agents
Medical Records
Sepsis
Arteries
Hemorrhage
Hypertension
Kidney

Keywords

  • Bypass
  • Children
  • Graft
  • Nephrectomy
  • Renovascular hypertension

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Results of surgical treatment for renovascular hypertension in children : 30 year single centre experience. / Stadermann, Marike B.; Montini, Giovanni; Hamilton, George; Roebuck, Derek J.; McLaren, Clare A.; Dillon, Michael J.; Marks, Stephen D.; Tullus, Kjell.

In: Nephrology Dialysis Transplantation, Vol. 25, No. 3, 03.2010, p. 807-813.

Research output: Contribution to journalArticle

Stadermann, MB, Montini, G, Hamilton, G, Roebuck, DJ, McLaren, CA, Dillon, MJ, Marks, SD & Tullus, K 2010, 'Results of surgical treatment for renovascular hypertension in children: 30 year single centre experience', Nephrology Dialysis Transplantation, vol. 25, no. 3, pp. 807-813. https://doi.org/10.1093/ndt/gfp537
Stadermann, Marike B. ; Montini, Giovanni ; Hamilton, George ; Roebuck, Derek J. ; McLaren, Clare A. ; Dillon, Michael J. ; Marks, Stephen D. ; Tullus, Kjell. / Results of surgical treatment for renovascular hypertension in children : 30 year single centre experience. In: Nephrology Dialysis Transplantation. 2010 ; Vol. 25, No. 3. pp. 807-813.
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AB - Background. We retrospectively reviewed the medical records of all patients who underwent surgery as part of the treatment of renovascular hypertension (RVH) at our centre between 1979 and 2008.Patients. Thirty-seven children (65% male) with a median age of 7.6 (0.4-17.9) years were identified with a median systolic blood pressure (SBP) of 140 (105-300) mm Hg prior to surgery. Bilateral renal artery stenosis and intra-renal disease were present in 19 (51%) patients, mid-aortic syndrome in 15 (40%), involvement of visceral arteries in eight out of 35 (23%) and coexisting cerebral disease in eight out of 30 (26%) investigated patients.Results. Surgical procedures (n = 53) included (i) nephrectomy (18, of which two unplanned and two secondary due to technical failure), (ii) renovascular surgery on the renal arteries (28, of which 18 had autologous surgery and 10 synthetic grafts inserted for revascularisation) and (iii) aortic reconstruction with (6) and without (1) a synthetic graft. Post-operative complications were haemorrhage (5), septicaemia (5) and chylous ascites (1). There were no perioperative deaths; two children died during follow-up. The SBP post-surgery improved to a median value of 116 (range 90-160) mm Hg. Twelve months after surgery, 16 (43%) children had normal blood pressure without treatment, 15 (41%) normal or improved on one to four antihypertensive drugs and four (11%) unchanged; no data were available for two (5%) children.Conclusion. Surgery effectively treated the hypertension of 90% of our children, when performed in conjunction with medical therapy and interventional radiology. In spite of aggressive surgical treatment, RVH is sometimes a progressive disease.

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