The Surgical Management of Renovascular Hypertension in Children and Young Adults

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 aetiology 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.