The surgical management of renovascular hypertension in children and young adults

Abstract

Objectives: to assess the outcome and durability of operative revascularisation in young patients with renovascular hypertension. Design: retrospective study. Method: the records of all young patients (under 25 years) operated on for renovascular hypertension at St Mary's Hospital 1988-1998 were reviewed. We assessed the aetiolgy of hypertension, operations performed, effect of treatment on blood pressure, renal function and requirement for antihypertensive medication during follow-up. Results: ten patients were identified who had been considered for surgery, of median age 16 years (22 months to 22 years). Fibromuscular dysplasia was present in five patients, mid-aortic syndrome (MAS) in four and neurofibromatosis in one. Operations performed were aortorenal bypass (three), aorto-aortic bypass ± renal bypass (three), splenorenal bypass (one) and autotransplantation (one). Of the three patients treated by balloon angioplasty, only one had a successful result. One patient with MAS is currently awaiting surgery. Over a median follow-up of 24 months (8-144), seven patients are normotensive off all antihypertensive medication. Of two patients on reduced doses of medication, one (splenorenal bypass) required surgical repair of a late (9 years) coeliac stenosis. Conclusions: The surgical treatment of renovascular hypertension in carefully selected young patients gives durable results. Blood pressure is well controlled long-term and the need for antihypertensive medication is removed altogether in the majority of patients.