Surgical management of pediatric renovascular hypertension and midaortic syndrome at a single-center multidisciplinary program

ObjectiveTo evaluate the outcomes of various surgical approaches in treatment renovascular hypertension and midaortic syndrome (MAS) children.MethodsWe performed a retrospective medical record review patients who had undergone surgery for from 2010 to 2018 at our center under care multidisciplinary team. The operative interventions included mesenteric artery growth improves circulation (MAGIC), tissue expander-stimulated lengthening arteries (TESLA), aortic bypass using polytetrafluorethylene, renal reimplantation, autotransplantation. MAGIC procedure uses meandering as free conduit bypass. TESLA is based on normal distal aorta iliac by gradual filling retroaortic expander several weeks, followed resection stenotic subsequent primary reconstruction.ResultsA total 39 were identified, 10 with isolated stenosis, 26 MAS, 3 systemic inflammatory vasculitis. median age presentation was 6.4 years (range, 0-16.3 years) 9.3 0-9.2 years), respectively. MAS-associated syndromes neurofibromatosis type 1 (15.4%) Williams (5.1%), although most cases idiopathic. At surgery, 33.3% stage (HTN), 53.8% 2 HTN, 12.8% blood pressure three antihypertensive medications. Follow-up 37 2.5 demonstrated 86.1%, HTN 8.3%, 5.6%, one medication entire cohort.ConclusionsThe patterns vascular involvement leading children are variable complex, requiring thoughtful planning decision-making. procedures provide feasible reconstruction autologous tissues will result normalization 85% after surgery.