Does Percutaneous Transluminal Angioplasty improve Blood pressure in Pediatric Patients?

Percutaneous Transluminal angioplasty caused significant improvement in blood pressure in pediatric renovascular hypertensive patients under 2 years of age. The study was published in the journal, 'European Journal of Pediatrics, 2022.' 

The renovascular disease has been found in 5-10% of children with secondary hypertension. Angioplasty or surgery is needed for children as medical management of renovascular hypertension is not sufficient. In most cases, renovascular hypertension requires endovascular treatment or surgery. Due to limited published research, it is challenging in pediatric cases. Hence researchers conducted a study to evaluate the treatment, and outcome of young children with renovascular hypertension undergoing angioplasty. 

A retrospective analysis of children under 2 years of age with renovascular hypertension was done from the period of 1998-2020. Demographics and treatment modalities of patients were noted. Blood pressure within a week after the procedures and at the last available visit was the primary outcome of the measurement. 

Results: 

• 66 angiographies were performed in 34 patients. 
• 1.03 years was the median age and systolic blood pressure was 130mm hg at the time of presentation. 
• 38% (13/34) were incidentally diagnosed and 18% (6/34) presented with heart failure. 
• 26 (76%) children had main renal artery stenosis and 17 (50%) had mid-aortic syndrome. 
• 17 (50%) had intrarenal, 6 (18%) mesenteric, and 3 (9%) cerebrovascular involvement.
• 20 patients underwent 45 percutaneous transluminal angioplasty procedures and 7 children underwent surgeries. 
• 44% of the 16 patients who underwent only percutaneous transluminal angioplasty blood pressure was normalized.
• 38% had improvement on the same or decreased treatment and 19% showed no improvement. 
• 7.5% (5/66) cases showed complications in angiographies. 
• In 4 out of 7 (57%) children who underwent surgery blood pressure was normalized, 2 showed improved (29%) and 1 unchanged (14%) blood pressure.

Thus, the researchers concluded that pediatric patients below 2 years of age and those having renovascular hypertension percutaneous transluminal angioplasty caused significant improvement in blood pressure and there were relatively fewer complications. They further recommended Surgery in cases where percutaneous transluminal angioplasty and medical treatments failed. 

To read the full article, click here: https://doi.org/10.1007/s00431-022-04550-4 

Kurt-Sukur, E.D., Brennan, E., Davis, M. et al. Presentation, treatment, and outcome of renovascular hypertension below 2 years of age. Eur J Pediatr (2022).