Mid-to-long term outcomes following renal artery angioplasty in children and young adults with renal artery stenosis: a retrospective review

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. Results11(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.