In Reply to: Re: Case 497_09 -- Renal artery stenosis in a child resistant to PTA posted by Bob Vogelzang on April 21, 1997 at 09:12:36:
We have also had the opportunity to attempt angioplasty on young
patients with this long single lesion on 5 or 6 occasions over the
last 3 or 4 years. I don't think that we have had a single case of
long-lasting clinical success and have had several cases that, like
this one were actually technical failures as well. We have path on 2
cases but the pathologist would not clearly classify the lesion as
particularly intimal in either case saying that other layers of the
vessel wall were also involved with the process that was mostly
fibrous and minimally muscular hyperplasia. We do have some younger
children with shorter lesions who have responded to angioplasty,
however, and because I am unsure about how to predict who will respond,
and who won't, we try them all. The non-responders become obvious very
rapidly, usually because they can't be dilated. As long as the balloon
is not oversized, I think that the possibility of rupture remains low.
Even when the initial plasty is successful, the follow-up almost
invariably demonstrates a rapid worsening of the lesion. After an
initial attempt, and recognition of the type of lesion, surgery seems
advisable as soon as symptoms warrant.