Surgical treatment and long-term outcome of renovascular hypertension in children and adolescents.

摘要

OBJECTIVES: This article describes the long-term outcome of surgical treatment in children with renovascular hypertension (RVH) over a 40-year period. DESIGN: Retrospective study. MATERIALS AND METHODS: Twenty-five consecutive patients, aged 5-21 years, underwent renal artery (RA) repair from 1967 to 1995. The disease consisted of fibromuscular dysplasia in 17 patients, Takayasu's arteritis in 7 and neurofibromatosis type 1 in one patient. RESULTS: Twenty-nine RAs were repaired. Primary procedures included aortorenal bypass (ARB) with prosthesis in 10 RAs, autologous vein in five or internal iliac artery in four as conduits, direct reimplantation (DR) in four and nephrectomy in two RAs. Immediate graft failure occurred in three patients despite no peri-operative deaths. After a mean follow-up of 24.4 years, seven patients required secondary nephrectomy. Autologous ARB or DR showed better RA patency and fewer chances for secondary nephrectomy than prosthetic ARB. Hypertension was cured or improved in 21 patients. The overall cumulative survival rate at 20 years was 84%. All five deaths, observed a mean of 12.6 years after the initial operation, were attributed to cardiovascular events. CONCLUSIONS: Surgical treatment, especially autologous ARB or DR, seems to provide durable results for paediatric RVH. Long-term observation and control of hypertension is mandatory.