Eliason Jonathan L, Coleman Dawn M, Criado Enrique, Kershaw David B, Blatt Neal B, Williams David M, Dasika Narasimham L, Cho Kyung J, Stanley James C
Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Section of Pediatric Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.
Pediatr Nephrol. 2016 May;31(5):809-17. doi: 10.1007/s00467-015-3275-3. Epub 2015 Dec 1.
Percutaneous transluminal angioplasty (PTA) for the treatment of pediatric renovascular hypertension (RVH) in contemporary practice is accompanied with ill-defined complications. This study examines the mode of pediatric renal PTA failures and the results of their surgical management.
Twenty-four children underwent remedial operations at the University of Michigan from 1996 to 2014 for failures of renal PTA. Their clinical courses were retrospectively reviewed and results analyzed.
Renal PTA of 32 arteries, including 13 with stenting, was performed for severe RVH in 12 boys and 12 girls, having a mean age of 9.3 years. Developmental ostial stenoses affected 22 children. PTA failures included: 27 restenoses and five thromboses. Remedial operations included: 13 renal artery-aortic reimplantations, one segmental renal artery-main renal artery reimplantation, ten aortorenal bypasses, one arterioplasty, one iliorenal bypass, and six nephrectomies for unreconstructable arteries; the latter all in children younger than 10 years. Follow-up averaged 2.1 years. Postoperatively, hypertension was cured, improved, or unchanged in 25, 54, and 21 %, respectively. There was no perioperative renal failure or mortality.
Renal PTA for the treatment of pediatric RVH due to ostial disease may be complicated by failures requiring complex remedial operations or nephrectomy, the latter usually affecting younger children.
在当代实践中，经皮腔内血管成形术（PTA）治疗小儿肾血管性高血压（RVH）会伴有一些不明确的并发症。本研究探讨小儿肾PTA失败的模式及其手术治疗结果。
1996年至2014年期间，24名儿童在密歇根大学因肾PTA失败接受了补救手术。对他们的临床病程进行回顾性分析并分析结果。
对12名男孩和12名女孩（平均年龄9.3岁）的严重RVH进行了32条动脉的肾PTA，其中13条动脉置入了支架。发育性开口狭窄累及22名儿童。PTA失败包括：27例再狭窄和5例血栓形成。补救手术包括：13例肾动脉-主动脉再植术、1例节段性肾动脉-主肾动脉再植术、10例主动脉-肾动脉搭桥术、1例血管成形术、1例髂-肾动脉搭桥术以及6例因动脉无法重建而进行的肾切除术；后者均为10岁以下儿童。平均随访2.1年。术后，高血压治愈、改善或无变化的比例分别为25%、54%和21%。无围手术期肾衰竭或死亡。
因开口病变行肾PTA治疗小儿RVH可能会出现失败情况，需要进行复杂的补救手术或肾切除术，后者通常影响年幼患儿。
