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Clinical characteristics and long-term outcomes of endovascular treatment of renal artery fibromuscular dysplasia with branch lesions

Abstract

Background

Renal artery fibromuscular dysplasia (FMD) can cause arterial stenosis, dissection, and aneurysm of renal arteries. This study aimed to analyze the clinical characteristics and evaluate the long-term outcomes of renal branch artery FMD in children and adults.

Methods

Sixty-one patients with renal artery FMD underwent endovascular treatment, including 23 children and 38 adults. They were divided into two groups, the main artery FMD group (n = 40, with severe stenosis located in the main renal artery) and the branch artery FMD group (n = 21, with only the branch lesions in unilateral or bilateral branch artery). The clinical characteristics and long-term outcomes of these pediatric and adult patients were evaluated.

Results

The incidence of branch FMD was higher in children than in adults (P = 0.005). Thirteen children showed one or more branch artery involvements. Hypertension and headache were the most common symptoms. The branch aneurysm with coexisting stenosis was more common in patients with branch artery FMD. During the follow-up, blood pressure was normal in 8 patients and lowered in 11 patients in the branch FMD group. The patient’s glomerular filtration was increased in 61 patients (P < 0.001). Four-year freedom from reintervention in 21 branch artery FMD patients was lower than that in 40 main artery FMD patients (P < 0.05).

Conclusions

A higher incidence of renal branch artery FMD was observed in children than in adults. Endovascular treatment with balloon angioplasty can be used for treating renal branch artery FMD.

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References

  1. 1.

    Narula N, Kadian-Dodov D, Olin JW (2018) Fibromuscular dysplasia: contemporary concepts and future directions. Prog Cardiovasc Dis 60:580–585. https://doi.org/10.1016/j.pcad.2018.03.001

    Article  PubMed  Google Scholar 

  2. 2.

    Brinza EK, Gornik HL (2016) Fibromuscular dysplasia: advances in understanding and management. Cleve Clin J Med 83:S45–s51. https://doi.org/10.3949/ccjm.83.s2.06

    Article  PubMed  Google Scholar 

  3. 3.

    Gornik HL, Persu A, Adlam D, Aparicio LS, Azizi M, Boulanger M, Bruno RM, de Leeuw P, Fendrikova-Mahlay N, Froehlich J, Ganesh SK, Gray BH, Jamison C, Januszewicz A, Jeunemaitre X, Kadian-Dodov D, Kim ES, Kovacic JC, Mace P, Morganti A, Sharma A, Southerland AM, Touzé E, van der Niepen P, Wang J, Weinberg I, Wilson S, Olin JW, Plouin PF (2019) First International Consensus on the diagnosis and management of fibromuscular dysplasia. Vasc Med 24:164–189. https://doi.org/10.1177/1358863x18821816

    Article  PubMed  Google Scholar 

  4. 4.

    Cotroneo AR, Amoroso L, Giammarino A, Galasso D, Taglialatela F, Timpani C, Gabrielli D (2017) Cutting balloon angioplasty (CBA) for the Treatment of renal artery fibromuscular dysplasia (FMD) in six patients: 5-year long-term results. Cardiovasc Intervent Radiol 40:546–552. https://doi.org/10.1007/s00270-016-1536-6

    Article  PubMed  Google Scholar 

  5. 5.

    Mousa AY, Campbell JE, Stone PA, Broce M, Bates MC, AbuRahma AF (2012) Short- and long-term outcomes of percutaneous transluminal angioplasty/stenting of renal fibromuscular dysplasia over a ten-year period. J Vasc Surg 55:421–427. https://doi.org/10.1016/j.jvs.2011.09.006

    Article  PubMed  Google Scholar 

  6. 6.

    Tullus K, Brennan E, Hamilton G, Lord R, McLaren CA, Marks SD, Roebuck DJ (2008) Renovascular hypertension in children. Lancet 371:1453–1463. https://doi.org/10.1016/s0140-6736(08)60626-1

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Green R, Gu X, Kline-Rogers E, Froehlich J, Mace P, Gray B, Katzen B, Olin J, Gornik HL, Cahill AM, Meyers KE (2016) Differences between the pediatric and adult presentation of fibromuscular dysplasia: results from the US Registry. Pediatr Nephrol 31:641–650. https://doi.org/10.1007/s00467-015-3234-z

    Article  PubMed  Google Scholar 

  8. 8.

    Davies MG, Saad WE, Peden EK, Mohiuddin IT, Naoum JJ, Lumsden AB (2008) The long-term outcomes of percutaneous therapy for renal artery fibromuscular dysplasia. J Vasc Surg 48:865–871. https://doi.org/10.1016/j.jvs.2008.05.030

    Article  PubMed  Google Scholar 

  9. 9.

    Louis R, Levy-Erez D, Cahill AM, Meyers KE (2018) Imaging studies in pediatric fibromuscular dysplasia (FMD): a single-center experience. Pediatr Nephrol 33:1593–1599. https://doi.org/10.1007/s00467-018-3983-6

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Steuer J, Bergqvist D, Björck M (2019) Surgical Renovascular Reconstruction for Renal Artery Stenosis and Aneurysm: Long-Term Durability and Survival. Eur J Vasc Endovasc Surg 57:562–568. https://doi.org/10.1016/j.ejvs.2018.09.014

    Article  PubMed  Google Scholar 

  11. 11.

    Knops NB, Cornelissen EA, Monnens LA (2011) Renal transplantation for fibromuscular dysplasia. Am J Transplant 11:852–856. https://doi.org/10.1111/j.1600-6143.2011.03455.x

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Duprey A, Chavent B, Meyer-Bisch V, Varin T, Albertini JN, Favre JP, Barral X, Ricco JB (2016) Editor's Choice - ex vivo renal artery repair with kidney autotransplantation for renal artery branch aneurysms: long-term results of sixty-seven procedures. Eur J Vasc Endovasc Surg 51:872–879. https://doi.org/10.1016/j.ejvs.2016.02.017

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Ishijima H, Ishizaka H, Sakurai M, Ito K, Endo K (1997) Partial renal embolization for pediatric renovascular hypertension secondary to fibromuscular dysplasia. Cardiovasc Intervent Radiol 20:383–386. https://doi.org/10.1007/s002709900173

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Teigen CL, Mitchell SE, Venbrux AC, Christenson MJ, McLean RH (1992) Segmental renal artery embolization for treatment of pediatric renovascular hypertension. J Vasc Interv Radiol 3:111–117. https://doi.org/10.1016/s1051-0443(92)72202-7

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Savard S, Steichen O, Azarine A, Azizi M, Jeunemaitre X, Plouin PF (2012) Association between 2 angiographic subtypes of renal artery fibromuscular dysplasia and clinical characteristics. Circulation 126:3062–3069. https://doi.org/10.1161/circulationaha.112.117499

    Article  PubMed  Google Scholar 

  16. 16.

    van Twist DJL, de Leeuw PW, Kroon AA (2018) Renal artery fibromuscular dysplasia and its effect on the kidney. Hypertens Res 41:639–648. https://doi.org/10.1038/s41440-018-0063-z

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Falkner B, Flinn SK, Gidding SS, Goodwin C, Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM (2017) Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140:e20171904. https://doi.org/10.1542/peds.2017-1904

    Article  PubMed  Google Scholar 

  18. 18.

    National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576

    Article  Google Scholar 

  19. 19.

    Yang YK, Zhang Y, Meng X, Yang KQ, Jiang XJ, Wu HY, Zhang HM, Song L, Wang LP, Gao LG, Zhou XL (2016) Clinical characteristics and treatment of renal artery fibromuscular dysplasia with percutaneous transluminal angioplasty: a long-term follow-up study. Clin Res Cardiol 105:930–937. https://doi.org/10.1007/s00392-016-1001-1

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Olin JW, Froehlich J, Gu X, Bacharach JM, Eagle K, Gray BH, Jaff MR, Kim ES, Mace P, Matsumoto AH, McBane RD, Kline-Rogers E, White CJ, Gornik HL (2012) The United States Registry for Fibromuscular Dysplasia: results in the first 447 patients. Circulation 125:3182–3190. https://doi.org/10.1161/circulationaha.112.091223

    Article  PubMed  Google Scholar 

  21. 21.

    Vo NJ, Hammelman BD, Racadio JM, Strife CF, Johnson ND, Racadio JM (2006) Anatomic distribution of renal artery stenosis in children: implications for imaging. Pediatr Radiol 36:1032–1036. https://doi.org/10.1007/s00247-006-0253-8

    Article  PubMed  Google Scholar 

  22. 22.

    Yong AS, Wyndham R, Lowe HC (2009) When ballooning alone is enough: successful treatment of hypertension secondary to renal artery fibromuscular dysplasia using angioplasty. Int J Cardiol 131:e85–e86. https://doi.org/10.1016/j.ijcard.2007.07.064

    Article  PubMed  Google Scholar 

  23. 23.

    Son JS (2015) Successful cutting balloon angioplasty in a child with resistant renal artery stenosis. BMC Res Notes 8:670. https://doi.org/10.1186/s13104-015-1673-z

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Lumsden AB, Salam TA, Walton KG (1996) Renal artery aneurysm: a report of 28 cases. Cardiovasc Surg 4:185–189. https://doi.org/10.1016/0967-2109(96)82312-x

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Klausner JQ, Harlander-Locke MP, Plotnik AN, Lehrman E, DeRubertis BG, Lawrence PF (2014) Current treatment of renal artery aneurysms may be too aggressive. J Vasc Surg 59:1356–1361. https://doi.org/10.1016/j.jvs.2013.11.062

    Article  PubMed  Google Scholar 

  26. 26.

    Savard S, Azarine A, Jeunemaitre X, Azizi M, Plouin PF, Steichen O (2013) Association of smoking with phenotype at diagnosis and vascular interventions in patients with renal artery fibromuscular dysplasia. Hypertension 61:1227–1232. https://doi.org/10.1161/hypertensionaha.111.00838

    CAS  Article  PubMed  Google Scholar 

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Funding

This study was supported by the National Natural Science Foundation of China (grant number 81301328) and Henan Provincial Medical Science and Technology Research Program (grant number 201602216).

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Correspondence to Shuiting Zhai.

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Li, K., Cui, M., Zhang, K. et al. Clinical characteristics and long-term outcomes of endovascular treatment of renal artery fibromuscular dysplasia with branch lesions. Pediatr Nephrol 36, 3169–3180 (2021). https://doi.org/10.1007/s00467-021-05067-y

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Keywords

  • Fibromuscular dysplasia
  • Renal artery stenosis
  • Renal artery aneurysm
  • Angioplasty
  • Pediatrics