Traitement chirurgical des lésions artérielles rénales chez l'enfant

Purpose

The aim of this retrospective study was to report the modalities and results of the surgical treatment of renal artery lesions in children.

Patients and methods

The series included 78 patients (43 girls, 35 boys), 16 months to 18 years of age, operated on from between 1975 to 1998. Lesions were bilateral in 24 cases. Due to bilateral procedures and to secondary or late re-operations, the number of surgical procedures was 106 (91 repairs and 15 nephrectomies). The repairs were performed by extracorporeal surgery in 22 cases and by in situ surgery in 69 cases. Whenever an arterial substitute was necessary, an arterial autograft was preferred

Results

Fibrodysplasia of the renal artery was the prevailing pathologic finding (63%). Associated lesions were observed in 64% of the patients: coarctation of the abdominal aorta (n=20), stenoses, obstructions, or aneurysms of splanchnic arteries (n=15), and pheochromocytoma (n=2). There was no postoperative death in this series. Seven postoperative thromboses occurred (7.7%). In the long-term follow-up, three recurrent stenoses, two stenoses of the opposite artery, and one aneurysm of a venous autograft were repaired surgically. In two patients, a stenosis of the abdominal aorta worsened and required an aortic by-pass at 3 and 12 years. A complete cure of arterial hypertension was observed in 87% of the patients. In young children, growth of the repairs appeared normal when age increased.

Conclusions

Surgery still has a prominent role in the treatment of these lesions. The prognosis is favorable since atheroma, visceral or renal lesions are usually lacking.