James C. Stanley, MD, Gerald B. Zelenock, MD, Louis M

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Presentation transcript:

Pediatric renovascular hypertension: A thirty-year experience of operative treatment James C. Stanley, MD, Gerald B. Zelenock, MD, Louis M. Messina, MD, Thomas W. Wakefield, MD Journal of Vascular Surgery Volume 21, Issue 2, Pages 212-227 (February 1995) DOI: 10.1016/S0741-5214(95)70263-6 Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 Aortic reimplantation of main renal arteries, beyond orifical stenoses. Journal of Vascular Surgery 1995 21, 212-227DOI: (10.1016/S0741-5214(95)70263-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Reimplantation of segmental renal artery, beyond its stenosis, into adjacent segmental renal artery. A, Preoperative arteriogram documenting stenosis and poststenotic dilation (arrow). B, Postoperative arteriogram demonstrates widely patent anastomosis (arrow). Journal of Vascular Surgery 1995 21, 212-227DOI: (10.1016/S0741-5214(95)70263-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Reimplantation of segmental renal artery, beyond its stenosis, into adjacent segmental renal artery. A, Preoperative arteriogram documenting stenosis and poststenotic dilation (arrow). B, Postoperative arteriogram demonstrates widely patent anastomosis (arrow). Journal of Vascular Surgery 1995 21, 212-227DOI: (10.1016/S0741-5214(95)70263-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Reimplantation of right renal artery to superior mesenteric artery, in end-to-side fashion. Journal of Vascular Surgery 1995 21, 212-227DOI: (10.1016/S0741-5214(95)70263-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Aortorenal bypass with internal iliac artery graft. Journal of Vascular Surgery 1995 21, 212-227DOI: (10.1016/S0741-5214(95)70263-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Primary operations (28) performed on 21 patients in era I. Note predominance of aortorenal bypasses with vein and operative dilation procedures. Journal of Vascular Surgery 1995 21, 212-227DOI: (10.1016/S0741-5214(95)70263-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Primary operations (18) performed on 13 patients in era II. Note continued predominance of aortorenal bypass with vein grafts. Journal of Vascular Surgery 1995 21, 212-227DOI: (10.1016/S0741-5214(95)70263-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Primary operations (33) performed on 24 patients in era III, including one patient who also underwent primary contralateral renal vascularization in era I. Note predominance of reimplantation procedures and frequent use of internal iliac artery grafts for aortorenal bypasses. Journal of Vascular Surgery 1995 21, 212-227DOI: (10.1016/S0741-5214(95)70263-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 8 Long-term control of hypertension in response to primary and secondary operation in eras I, II, and III. The cumulative outcome for all 57 patients was 79% cured, 19% improved, and 2% failed. Journal of Vascular Surgery 1995 21, 212-227DOI: (10.1016/S0741-5214(95)70263-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 9 Renal artery reimplantation into aorta in patient undergoing eventual abdominal aortoplasty. A, Preoperative arteriogram in 10-month-old child with normal-appearing left renal artery and no visualization of right renal artery that was found to be occluded at time of operation. B, Postoperative arteriogram at 3 years of age reveals normal appearance of reimplanted right renal artery, and evolving sterosis of left renal artery. C, Postoperative arteriogram at 5 years of age revealing stable reimplanted right renal artery and reimplantation of left renal artery into aorta. Note evolving upper abdominal aortic narrowing. D, Postoperative arteriogram at 7 years of age after undergoing expanded PTFE patch aortoplasty because of recurrent hypertension due to suprarenal aortic coarctation. Journal of Vascular Surgery 1995 21, 212-227DOI: (10.1016/S0741-5214(95)70263-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 9 Renal artery reimplantation into aorta in patient undergoing eventual abdominal aortoplasty. A, Preoperative arteriogram in 10-month-old child with normal-appearing left renal artery and no visualization of right renal artery that was found to be occluded at time of operation. B, Postoperative arteriogram at 3 years of age reveals normal appearance of reimplanted right renal artery, and evolving sterosis of left renal artery. C, Postoperative arteriogram at 5 years of age revealing stable reimplanted right renal artery and reimplantation of left renal artery into aorta. Note evolving upper abdominal aortic narrowing. D, Postoperative arteriogram at 7 years of age after undergoing expanded PTFE patch aortoplasty because of recurrent hypertension due to suprarenal aortic coarctation. Journal of Vascular Surgery 1995 21, 212-227DOI: (10.1016/S0741-5214(95)70263-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 9 Renal artery reimplantation into aorta in patient undergoing eventual abdominal aortoplasty. A, Preoperative arteriogram in 10-month-old child with normal-appearing left renal artery and no visualization of right renal artery that was found to be occluded at time of operation. B, Postoperative arteriogram at 3 years of age reveals normal appearance of reimplanted right renal artery, and evolving sterosis of left renal artery. C, Postoperative arteriogram at 5 years of age revealing stable reimplanted right renal artery and reimplantation of left renal artery into aorta. Note evolving upper abdominal aortic narrowing. D, Postoperative arteriogram at 7 years of age after undergoing expanded PTFE patch aortoplasty because of recurrent hypertension due to suprarenal aortic coarctation. Journal of Vascular Surgery 1995 21, 212-227DOI: (10.1016/S0741-5214(95)70263-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 9 Renal artery reimplantation into aorta in patient undergoing eventual abdominal aortoplasty. A, Preoperative arteriogram in 10-month-old child with normal-appearing left renal artery and no visualization of right renal artery that was found to be occluded at time of operation. B, Postoperative arteriogram at 3 years of age reveals normal appearance of reimplanted right renal artery, and evolving sterosis of left renal artery. C, Postoperative arteriogram at 5 years of age revealing stable reimplanted right renal artery and reimplantation of left renal artery into aorta. Note evolving upper abdominal aortic narrowing. D, Postoperative arteriogram at 7 years of age after undergoing expanded PTFE patch aortoplasty because of recurrent hypertension due to suprarenal aortic coarctation. Journal of Vascular Surgery 1995 21, 212-227DOI: (10.1016/S0741-5214(95)70263-6) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions