Agrawal Hitesh, Moodie Douglas, Qureshi Athar M, Acosta Alisa A, Hernandez Jose A, Braun Michael C, Justino Henri
Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Lillie Frank Abercrombie Section of Cardiology, Houston, Texas.
Texas Children's Hospital and Baylor College of Medicine, C. E. Mullins Cardiac Catheterization Laboratories, Houston, Texas.
Congenit Heart Dis. 2018 May;13(3):349-356. doi: 10.1111/chd.12608. Epub 2018 Apr 10.
Renovascular hypertension (RVH) can be caused by renal artery stenosis (RAS) and/or middle aortic syndrome (MAS).
Patients who received surgical or transcatheter treatment for RVH between 1/1991 and 11/2017 were retrospectively reviewed using age = adjusted blood pressure ratio (BPR).
Fifty-three patients diagnosed with RVH at a median age of 4.5 (0-18) years were included. Vascular involvement ranged from MAS with RAS (20), RAS only (32), and MAS only (1). The first intervention was transcatheter in 47 patients (transcatheter group: angioplasty = 41, stenting = 5, and thrombectomy = 1), and surgical in 6 patients (surgical group), occurring at a median age of 6.2 (0.1-19.6) years. There was a change toward transcatheter interventions as the first procedure over the study period. First reinterventions in the transcatheter group (27 lesions in 18 patients) were repeat transcatheter (in 20 lesions) and surgery (7 lesions) at a median of 92 (2-2555) days; in the surgical group (5 lesions in 4 patients) first reinterventions were transcatheter (4 lesions) and repeat surgery (1) at a median of 2.2 (1.1-12.0) years. A total of 136 transcatheter and 30 surgical discrete interventions were performed. There was a significant decline in antihypertensive medications and BPR at 4-6 months after the first intervention and on last follow-up in patients initially treated by transcatheter means while the decline was not significant in the surgical group (limited by small sample size). Complications were significantly more common in the surgical group (P < .01), 11/27 (41%) vs 10/136 (7.4%). Four patients died (2 from each group): 2 with congenital renal artery atresia and MAS, 2 with MAS and RAS. The median follow-up interval was 3.6 (0.1-35.2) years.
Pediatric patients with RVH treated with transcatheter means as the first intervention had significant improvement in BPR, as well as decline in antihypertensive medications and were less likely to suffer major complications.
肾血管性高血压（RVH）可由肾动脉狭窄（RAS）和/或中主动脉综合征（MAS）引起。
回顾性分析1991年1月至2017年11月间接受手术或经导管治疗的RVH患者，采用年龄校正血压比值（BPR）。
纳入53例诊断为RVH的患者，中位年龄为4.5（0 - 18）岁。血管受累情况包括合并RAS的MAS（20例）、单纯RAS（32例）和单纯MAS（1例）。首次干预中，47例患者接受经导管治疗（经导管治疗组：血管成形术 = 41例，支架置入术 = 5例，血栓切除术 = 1例），6例患者接受手术治疗（手术组），首次干预的中位年龄为6.2（0.1 - 19.6）岁。在研究期间，作为首选治疗方法，经导管干预呈上升趋势。经导管治疗组的首次再次干预（1）在18例患者中的27处病变，是重复经导管治疗（20处病变）和手术（7处病变），中位时间为92（2 - 2555）天；手术组（4例患者中的5处病变）的首次再次干预是经导管治疗（4处病变）和再次手术（1处病变），中位时间为2.2（1.1 - 12.0）年。共进行了136次经导管和30次手术的独立干预。首次干预后4 - 6个月以及最后一次随访时，最初接受经导管治疗的患者的降压药物和BPR显著下降，而手术组的下降不显著（受样本量小的限制）。手术组的并发症明显更常见（P < 0.01），11/27（41%）对比10/136（7.4%）。4例患者死亡（每组2例）：2例患有先天性肾动脉闭锁和MAS，2例患有MAS和RAS。中位随访时间为3.（0.1 - 35.2）年。
以经导管治疗作为首次干预的小儿RVH患者，BPR有显著改善，降压药物减少，且发生严重并发症的可能性较小。
