Percutaneous transluminal angioplasty in aortic and renal stenosis in a child with neurofibromatosis

Treatment of severe renal artery stenosis by percutaneous transluminal renal angioplasty and stent implantation: review of the pediatric experience: apropos of two cases

The clinical course of two children with mid-aortic syndrome and renal artery stenosis (RAS) who suffered from severe arterial hypertension is described. Hypertension was uncontrollable by antihypertensive medication and was managed by percutaneous transluminal renal angioplasty (PTRA) with stent implantation. The pediatric experience with PTRA is limited, and there are only few cases reported with additional stent implantation. Complications of these procedures are well known from experience with adult patients. However, since surgical revascularization may be technically difficult especially in small children, PTRA with or without stenting should be considered as a valuable treatment option in pediatric RAS.

Coarctations of descending and abdominal aorta: long-term results of surgical therapy

PURPOSE

Nonarteriosclerotic and nonarteritic descending and abdominal aortic coarctation (DAAC) is a rare disease with a great variety of morphologic findings. The additional affliction of renal and other splanchnic arteries often affords complex corrective procedures. We report on our single-center long-term experiences with operative treatment of this malformation.

METHODS

Over a period of 21 years, 15 patients (10 female and 5 male patients; age range, 8 to 57 years) were operated on for DAAC. Six patients had additional stenoses of eight renal arteries, and three had splanchnic arterial obstructions. At 4 to 25 years after the operation, all surviving patients underwent a clinical and a spiral computed tomography examination.

RESULTS

There was one intraoperative death due to exsanguination after the rupture of a poststenotic aneurysm of the infrarenal aorta. Fourteen patients were discharged free of symptoms. During follow-up, four repeated operations were necessary for renal arterial bypass stenoses or aneurysms. One late death occurred as the result of an unrelated disease.

CONCLUSIONS

Complete operative correction of DAAC usually can be accomplished as a single-stage procedure with low morbidity and mortality rates. The reconstruction of all renal arteries is essential to cure hypertension. Consequent follow-up is recommended for detection of late postoperative complications.

Cervical vertebral arteriovenous fistula balloon embolization in a patient with neurofibromatosis type 1

The authors present a patient with neurofibromatosis type 1 associated with cervical kyphosis, a cervical vertebral arterial fistula, and contralateral vertebral arterial occlusion. The fistula was successfully treated with detachable balloons.