Educational Exhibit Abstract No. 422 - Diagnosis and treatment of renovascular hypertension in children

Abstract

Learning Objectives To describe and illustrate with examples the techniques and unique management challenges in diagnosing and treating renovascular hypertension in children. Background Renovascular hypertension (RVH) is an uncommon yet important and potentially curable cause of secondary hypertension in children, accounting for approximately 10% of cases. The management of RVH in the pediatric population presents specific challenges related to both the size and expected growth of the involved vessels as well as the often bilateral, subsegmental, and intrarenal distribution of disease. A variety of laboratory and imaging criteria are useful in establishing a diagnosis of RVH, however catheter angiography augmented by direct renal vein renin measurement remains the test of choice. Likewise, percutaneous transluminal renal artery angioplasty remains a highly effective front line treatment option with the goal of reducing or eliminating the need for medical therapy and avoiding complex surgical revascularization. Clinical Findings/Procedure Details The clinical pathway for the diagnosis of RVH will be discussed including the relevant pre-procedural non-invasive imaging and laboratory tests aimed at excluding more common causes of secondary hypertension. The angiographic features of RVH will be illustrated in multiple cases, with an emphasis on findings unique to pediatric patients. The diagnostic relevance and proper technique for direct renal vein renin sampling will be described. Angiographic technique and equipment particularly useful for imaging and successful treatment of the pediatric population will be reviewed. Additional cases will illustrate the uncommon occurrence of angioplasty failure requiring stent placement as well as unexpected causes of hypertension encountered during angiography. Conclusion and/or Teaching Points Interventional radiologists play a pivotal role in the diagnosis and treatment renovascular hypertension in children. Knowledge of the unique features of this disease and technical challenges in the pediatric population is critical in providing potentially curative endovascular therapy.