Vascular disease is the name given to a variety of illnesses that affect the arteries and veins of the body. In children, vascular disease generally refers to a condition affecting the largest artery in the body, the aorta, and its branches to the kidneys and intestines. The most common disease is that of the renal (kidney) arteries.
C.S. Mott Children’s Hospital is an international referral center for children with complex vascular disease. Our vascular surgeons are renowned for their experience with even the most complex forms of renal artery disease, operating on roughly 80% of children in the U.S. who require surgery for this condition. Our patients receive seamlessly integrated care from a multidisciplinary team that, in addition to the vascular surgery team, includes leading specialists in pediatric nephrology, interventional radiology, and critical care. We work to coordinate every step of your child’s care, whenever possible arranging appointments so that multiple specialists can be seen in a single visit. Treatment strategies are a coordinated effort between every physician involved in your child’s care.
What is renal artery disease?
The renal arteries are the vessels that carry blood to kidneys. These arteries, like others in the human body, can become obstructed, a condition called renal artery stenosis. Generally when renal artery stenosis is diagnosed in children it is a result of narrowing of the artery that occur during fetal growth, before birth. Reductions in blood flow to the kidneys because this narrowing often results in severe hypertension (high blood pressure).
If untreated, renal artery stenosis and hypertension caused by renal artery stenosis may contribute to a number of serious problems, including:
- Stroke, seizures, mental retardation
- Thickening of the heart muscle (hypertrophy), which can result in heart failure
- Failure to thrive, falling behind major benchmarks of weight and height
- Kidney failure requiring dialysis
Diagnosing renal artery disease
Early detection of vascular disease can reduce the risk of serious complications. C.S. Mott Children’s Hospital offers an unparalleled level of expertise appropriately diagnosing and establishing the severity of renal artery disease in a way that positions each child with the best chances for effective treatment.
We assess severity of renal artery disease with a thorough patient history and examination. The exam includes imaging of the kidney arteries with an abdominal ultrasound scan, or by arteriography, which provides direct visualization of the artery's interior. Arteriography may be performed by magnetic resonance angiography (like MRIs) or with catheters placed into the artery with injection of dye that allows visualization of the vessel. The latter usually requires advancement of a small catheter (tube) through the arteries in the groin and an injection of contrast dye.
Treating renal artery disease
We work closely with the world-class nephrology team in the C.S. Mott Children’s Hospital Pediatric Hypertension Program to manage hypertension caused by renal artery stenosis through medication and appropriate monitoring.
Surgical repair is a frequent option for many children with renal vascular disease. Often, surgical repair opens up a new world of opportunity for children with renal artery disease, reducing limitations on physical activity and allowing them to live a normal, healthy lifestyle along with their peers.
Our pediatric vascular surgery team has a great deal of expertise caring for children with vascular disease, many of whom are referred to us from children’s hospitals throughout the country and abroad. As a result of our extensive experience, we are able to offer the option of surgery to many children even with the most severe stenosis.
The goal of surgical treatment is to restore blood flow to the kidney. Surgical interventions include either removal of the obstructing material and reconstructing the normal artery beyond the obstruction, or a bypass usually using a small nonessential artery from within the abdomen. In highly selected children this may be done by placing a small balloon within the artery and expanding it, resulting in a dilatation of the vessel. This is known as a balloon angioplasty. We don’t stent children, having learned from our extensive experience that, while stents are a good option for adults, they are not the best course for children.
Benefits in the form of a cure or marked improvement in the control of the hypertension range from 60-95%, depending on the type of obstructing disease and age of the patient. Patients are usually hospitalized for 1 or 2 days if a balloon angioplasty can be performed, or 7 to 10 days if a conventional surgical operation is undertaken.
Take the next step:
Renal artery disease is a complex disorder whose side-effects eventually harm the heart, brain, blood vessels and kidneys of children with this rare disorder. Effective treatment requires multidisciplinary care from an experienced team. C.S. Mott Children’s Hospital has become an international destination for surgical repair of renal artery disease. We look forward to partnering with your family to care for your child.
Schedule an appointment by calling us at 888-287-1082.