Pediatric renal artery occlusive disease and renovascular hypertension. Etiology, diagnosis, and operative treatment
J. C. Stanley and W. J. Fry
Forty pediatric patients (16 girls and 24 boys) 22 months to 17 years old
underwent operation for renovascular hypertension. Ostial stenoses were
present in 20 children; midrenal lesions were present in eight; and
isolated segmental disease was present in 12 patients and was combined with
main renal artery stenoses in three patients. Neurofibromatosis affected
ten patients, including three having abdominal aortic anomalies. Abdominal
aortic coarctation affected five other children. Hypertensive urograms were
abnormal only 27% of the time. Renin assays were helpful in identifying
functionally important renal ischemia. Fifty-one primary surgical
procedures were undertaken, including one simultaneous and nine staged
operations for bilateral disease. There were two primary nephrectomies. Six
patients underwent later secondary operations. Thirty-four patient (85%)
were cured of hypertension, the conditions of five (12.5%) were improved,
and one (2.5%) was classified a therapeutic failure. Carefully performed
arterial reconstructive surgery will benefit most pediatric patients with
renovascular hypertension.
