Long-term outcome with surgical treatment of renovascular hypertension.

PURPOSE: The purpose of this study was to prospectively study certain surgical approaches to renal artery stenosis and the long-term outcomes.
METHODS: One hundred thirty-six children were evaluated for severe hypertension, 53 had renovascular lesions. The approach to diagnosis, the role of balloon angioplasty, comparison of reimplantation with bypass grafting, the role of vein grafts and the incidence of graft aneurysm formation, the possible protective effect of vein graft mesh wraps, and approaches to treatment of associated aortic and visceral artery narrowing were all studied prospectively and the long-term results evaluated.
RESULTS: Fibromuscular hyperplasia (FMH) was the main etiology (45 of 53 patients), with 17 of these having midaortic involvement as well. Sex distribution was equal; average age was 9 years. Malignant hypertension was the rule, and three had renal failure. Twenty-three of the 45 had bilateral vessel involvement. Fifty of the 53 patients underwent operation. Aortography was the most definitive approach to diagnosis and planning therapy. Balloon angioplasty was used in eight patients, but this only worked long term in branch vessel locations or at graft anastomoses. A variety of surgical approaches were used depending on the pathology encountered. Thirty-eight patients underwent revascularization, seven underwent primary nephrectomy, five underwent primary partial nephrectomy, and 12 had aortoaortic bypass performed. Seventy percent were cured, 26% improved; and 4% did not respond to treatment with up to 16 years of follow-up. There was no mortality.