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Youssef S, Gill AE, Shah JH, Kennedy SS, Riar SK, Hawkins CM. Mid-to-long term outcomes following renal artery angioplasty in children and young adults with renal artery stenosis: a retrospective review. Pediatr Nephrol 2025:10.1007/s00467-025-06727-z. [PMID: 40164847 DOI: 10.1007/s00467-025-06727-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2024] [Revised: 01/28/2025] [Accepted: 02/12/2025] [Indexed: 04/02/2025]
Abstract
BACKGROUND This study investigates the efficacy of renal artery angioplasty for pediatric renovascular hypertension (RVH) and describes the role of pre-procedural diagnostic imaging. METHODS Clinical data of patients who underwent angioplasty for RVH from July 2014-May 2023 at a single, tertiary-care children's hospital were retrospectively analyzed. Renal angiography was performed in 74 children, mean age: 10.6 years (range, 3mos-20y). Mean follow-up: 2.5 years (range, 4d-10.4y). 45 angioplasty procedures were performed on 28 patients. RESULTS 11(39.3%) were cured (normotensive, no anti-hypertensive medications), 10(35.7%) were improved (improved BP, decreased anti-hypertensive dose or number of meds), and 7(25%) failed (no improvement) following 1st angioplasty. Of the 17 patients who improved/failed, 12 had a 2nd angioplasty procedure. Of those, 3(25%) were treated with cutting-balloons. 2(16.7%) were cured, 8(66.7%) improved, and 2(16.7%) failed. 5 patients underwent a 3rd angioplasty procedure. 4(80%) were treated with cutting-balloons. 3 (60%) of the 5 patients were cured, 2 (40%) improved. In all, 16/28(57.1%) of patients were cured, and 12/28(42.9%) improved. 19 patients with abnormal angiography had normal CTA(10), MRA(3), and US(17). 14 patients with normal angiography had abnormal CTA(4), MRA(2), and US(13). Major complication rate was 8.9%(4/45) and included renal artery stent with residual in-stent stenosis, arterial extravasation following cutting-balloon angioplasty, arterial dissection, and vasospasm, partially resolved with nitroglycerin/TPA. CONCLUSIONS Angioplasty is an efficacious treatment for pediatric RVH, but may require more than one procedure to achieve successful clinical results. Angiography should be pursued when RVH is suspected, as other imaging modalities are commonly discordant with angiography.
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Affiliation(s)
- Salma Youssef
- University College Dublin School of Medicine, Belfield, Dublin, Ireland.
| | - Anne E Gill
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Emory and Children's Pediatric Institute, Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
| | - Jay H Shah
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Emory and Children's Pediatric Institute, Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
| | - Sabina S Kennedy
- Emory and Children's Pediatric Institute, Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
- Division of Pediatric Nephrology, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Sandeep K Riar
- Emory and Children's Pediatric Institute, Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
- Division of Pediatric Nephrology, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Emory and Children's Pediatric Institute, Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
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Li P, Yang X, Niu G, Yan Z, Zhang B, Yang M. Percutaneous Transluminal Renal Angioplasty for Pediatric Hypertension Secondary to Total Renal Artery Occlusion. J Vasc Interv Radiol 2024; 35:1332-1339. [PMID: 38499268 DOI: 10.1016/j.jvir.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 03/20/2024] Open
Abstract
PURPOSE To assess the feasibility and effectiveness of percutaneous transluminal renal angioplasty (PTRA) for pediatric renovascular hypertension (RVH) secondary to total renal artery occlusion (RAO). MATERIALS AND METHODS From 2011 to 2021, 13 pediatric patients with RVH confirmed with 14 renal artery occlusions were reviewed. The mean age was 11.2 years (range, 4-16 years). Nine occlusions involved main artery occlusion, and 5 involved branch occlusion. Blood pressure ratio (BPR) was defined as the ratio of the actual measured blood pressure (BP) value to the 95th percentile value adjusted for age, sex, and height. RESULTS PTRA was performed in 9 patients (9/13, 69%). Technical success was achieved in 5 patients (5/9, 56%), with stent placement in 2 children (2/9, 22%). During the 12-month follow-up, restenosis was identified in both of the stent-receiving patients at the 12-month follow-up visit (2/9, 22%). Mean systolic BPR decreased from 1.20 (SD ± 0.07) to 0.96 (SD ± 0.06; P = .003), mean diastolic BPR decreased from 1.19 (SD ± 0.07) to 0.95 (SD ± 0.08; P = .005), and the number of medications required decreased from 3.8 (SD ± 0.8) to 2.4 (SD ± 0.9; P = .052) after PTRA. Subsequent to PTRA, the mean glomerular filtration rate of the occluded kidney improved from 19.5 mL/min (SD ± 12.3) to 36.3 mL/min (SD ± 10.8; P = .007), and the mean longitudinal dimension of the affected kidneys significantly increased from 8.2 cm (SD ± 1.5) to 9.2 cm (SD ± 1.7; P = .006). CONCLUSIONS Endovascular treatment is often feasible for pediatric patients with RAO, results in acceptable BP control, and preserves renal function.
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Affiliation(s)
- Pengyu Li
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Xinzhi Yang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Guochen Niu
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Ziguang Yan
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Bihui Zhang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Min Yang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China.
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Østergaard ML, Hjort N, Buus NH, Reinhard M. Evidence for routine brain-to-pelvis imaging and antiplatelet therapy in patients diagnosed with fibromuscular dysplasia. J Clin Hypertens (Greenwich) 2024; 26:890-901. [PMID: 39012329 DOI: 10.1111/jch.14865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 05/19/2024] [Accepted: 06/03/2024] [Indexed: 07/17/2024]
Abstract
Fibromuscular dysplasia (FMD) is a disease of the musculature of arterial walls leading to stenoses, aneurysms, and dissections. The purpose of this report was to summarize the evidence for (1) one-time routine imaging from brain-to-pelvis and (2) lifelong antiplatelet therapy, for example, aspirin, for patients diagnosed with FMD as suggested by an international consensus report from 2019. PubMed was systematically searched, and the evidence providing a basis for the current consensus points, as well as articles published since, were reviewed. In four registries evaluating patients with FMD, the prevalence of multivessel involvement, aneurysms, and dissections was reported to be 43.5%-66.3%, 21.6%-30.6%, and 5.6%-28.1%, respectively. Any antiplatelet drug was used in 72.9% of patients, and aspirin was prescribed in up to 70.2% of patients. Based on the high prevalence of vascular manifestations, their associated morbidity, and the potential for endovascular or surgical intervention, the suggestion of one-time brain-to-pelvis screening with computed tomography angiography or magnetic resonance angiography is well supported. Contrarily, the evidence to support the consensus statement of lifelong antiplatelet therapy to all patients in the absence of contraindications is more uncertain since a beneficial effect has not been demonstrated specifically in patients with fibromuscular dysplasia. Therefore, until the efficacy and safety of primary thromboprophylaxis have been demonstrated in this patient group specifically, it may be equally appropriate to only use antiplatelet agents in patients with a clear indication after individual evaluation according to risk factors for thrombotic and thromboembolic complications.
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Affiliation(s)
- Mikkel Landgraff Østergaard
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Niels Hjort
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Niels Henrik Buus
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Mark Reinhard
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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Redhead ECG, Paessler A, Arslan Z, Patel P, Minhas K, Forman C, Hollis P, Lava S, Ionescu F, Manuel D, Ray S, Kessaris N, Giardini A, Ratnamma V, Dobby N, Tullus K, Simmonds J, Stojanovic J. Cardiovascular outcomes improve in children with renovascular hypertension following endovascular and surgical interventions. Pediatr Nephrol 2024; 39:521-530. [PMID: 37658875 PMCID: PMC10728245 DOI: 10.1007/s00467-023-06123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Renovascular hypertension (RenoVH) is a cause of hypertension in children. A common cause of RenoVH is renal artery stenosis which acts by reducing blood supply to renal parenchyma and activating the renin-angiotensin-aldosterone axis, often leading to cardiac remodelling. This longitudinal observational study aims to describe occurrence of cardiovascular changes secondary to RenoVH and also any improvement in cardiac remodelling after successful endovascular and/or surgical intervention. METHODS All patients with RenoVH referred to our centre, who received ≥ 1 endovascular intervention (some had also undergone surgical interventions) were included. Data were collected by retrospective database review over a 22-year period. We assessed oscillometric blood pressure and eight echocardiographic parameters pre- and post-intervention. RESULTS One hundred fifty-two patients met inclusion criteria and had on average two endovascular interventions; of these children, six presented in heart failure. Blood pressure (BP) control was achieved by 54.4% of patients post-intervention. Average z-scores improved in interventricular septal thickness in diastole (IVSD), posterior Wall thickness in diastole (PWD) and fractional shortening (FS); left ventricular mass index (LVMI) and relative wall thickness (RWT) also improved. PWD saw the greatest reduction in mean difference in children with abnormal (z-score reduction 0.25, p < 0.001) and severely abnormal (z-score reduction 0.23, p < 0.001) z-scores between pre- and post-intervention echocardiograms. Almost half (45.9%) had reduction in prescribed antihypertensive medications, and 21.3% could discontinue all antihypertensive therapy. CONCLUSIONS Our study reports improvement in cardiac outcomes after endovascular + / - surgical interventions. This is evidenced by BP control, and echocardiogram changes in which almost half achieved normalisation in systolic BP readings and reduction in the number of children with abnormal echocardiographic parameters. A higher resolution version of the Graphical abstract is available as Supplementary information. SUPPLEMENTARY INFORMATION
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Affiliation(s)
- Emily C G Redhead
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Alicia Paessler
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Zainab Arslan
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Premal Patel
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Kishore Minhas
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Colin Forman
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Paolo Hollis
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Sebastiano Lava
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Florin Ionescu
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Devi Manuel
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Samiran Ray
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Nicos Kessaris
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Alessandro Giardini
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Vineetha Ratnamma
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Nadine Dobby
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Kjell Tullus
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Jacob Simmonds
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Jelena Stojanovic
- University College London Great Ormond Street Institute of Child Health, London, UK.
- Great Ormond Street Hospital for Children NHS Foundation Trust, Renal Unit, Level 7, Southwood Building, Great Ormond Street, London, WC1N 3JH, UK.
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Li P, Yang X, Niu G, Yan Z, Zhang B, Yang M. Endovascular Treatment for Total Renal Artery Occlusion in Paediatric Patients. Eur J Vasc Endovasc Surg 2023; 66:745-746. [PMID: 37536516 DOI: 10.1016/j.ejvs.2023.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 07/05/2023] [Accepted: 07/27/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Pengyu Li
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Xinzhi Yang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Guochen Niu
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Ziguang Yan
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Bihui Zhang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Min Yang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China.
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