ТАКТИКА ЛЕЧЕНИЯ ТЯЖЕЛОЙ РЕФРАКТЕРНОЙ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ У ПОДРОСТКА С ГИПОПЛАЗИЕЙ БРЮШНОЙ АОРТЫ И СТЕНОЗАМИ ПОЧЕЧНЫХ АРТЕРИЙ: КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ

Abstract

Renovascular arterial hypertension (AH) is one of the most common and prognostically most serious secondary hypertensions in children, however, descriptions of renal artery stenosis as part of middle aortic syndrome are quite rarely described Worldwide, and the etiology of this syndrome remains unclear in more than half of all the cases. Treatment approaches include a combination of complex conservative and surgical endovascular techniques that require constant monitoring of effectiveness. A clinical case observation and treatment tactics for refractory hypertension in an adolescent patient with hypoplasia of the abdominal aorta, stenosis of both renal arteries, a progressive decline in the function and volume of the left kidney (a picture of shrinkage of the left kidney on scintigraphy, an increase in hyperazotemia) and left ventricular (LV) hypertrophy is presented. Due to the ineffectiveness of drug antihypertensive therapy, the patient subsequently underwent aortoaortic bypass surgery of the abdominal aorta with prosthetics and implantation of the left renal artery into the shunt, balloon vasodilation with the installation of stents in the lower pole artery of the left kidney and the right renal artery. Over time, there was an improvement in the velocity parameters of the vessels of both kidneys, a decrease in blood pressure to values close to normal and regression of LV hypertrophy. Conclusion: the treatment tactics for a patient with renovascular hypertension and hypoplasia of the abdominal aorta, including drug methods in combination with two-stage surgical correction - the application of an aortoaortic shunt and endovascular treatment - turned out to be the most effective in terms of controlled hypertension.