Surgical management of pediatric renin-mediated hypertension secondary to renal artery occlusive disease and abdominal aortic coarctation
Renovascular hypertension (RVH) associated with renal artery and abdominal aortic narrowings is the third most common cause of pediatric hypertension. Untreated children may experience major cardiopulmonary complications, stroke, renal failure, and death. The impetus of this study was to describe th...
Gespeichert in:
| Veröffentlicht in: | Journal of vascular surgery Jg. 72; H. 6; S. 2035 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
United States
01.12.2020
|
| Schlagworte: | |
| ISSN: | 1097-6809, 1097-6809 |
| Online-Zugang: | Weitere Angaben |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| Abstract | Renovascular hypertension (RVH) associated with renal artery and abdominal aortic narrowings is the third most common cause of pediatric hypertension. Untreated children may experience major cardiopulmonary complications, stroke, renal failure, and death. The impetus of this study was to describe the increasingly complex surgical practice for such patients with an emphasis on anatomic phenotype and contemporary outcomes after surgical management as a means of identifying those factors responsible for persistent or recurrent hypertension necessitating reoperation.
A retrospective analysis was performed of consecutive pediatric patients with RVH undergoing open surgical procedures at the University of Michigan from 1991 to 2017. Anatomic phenotype and patient risk factors were analyzed to predict outcomes of blood pressure control and the need for secondary operations using ordered and binomial logistic multinomial regression models, respectively.
There were 169 children (76 girls, 93 boys) who underwent primary index operations at a median age of 8.3 years; 31 children (18%) had neurofibromatosis type 1, 76 (45%) had abdominal aortic coarctations, and 28 (17%) had a single functioning kidney. Before treatment at the University of Michigan, 51 children experienced failed previous open operations (15) or endovascular interventions (36) for RVH at other institutions. Primary surgical interventions (342) included main renal artery (136) and segmental renal artery (10) aortic reimplantation, renal artery bypass (55), segmental renal artery embolization (10), renal artery patch angioplasty (8), resection with reanastomosis (4), and partial or total nephrectomy (25). Non-renal artery procedures included patch aortoplasty (32), aortoaortic bypass (32), and splanchnic arterial revascularization (30). Nine patients required reoperation in the early postoperative period. During a mean follow-up of 49 months, secondary interventions were required in 35 children (21%), including both open surgical (37) and endovascular (14) interventions. Remedial intervention to preserve primary renal artery patency or a nephrectomy if such was impossible was required in 22 children (13%). The remaining secondary procedures were performed to treat previously untreated disease that became clinically evident during follow-up. Age at operation and abdominal aortic coarctation were independent predictors for reoperation. The overall experience revealed hypertension to be cured in 74 children (44%), improved in 78 (46%), and unchanged in 17 (10%). Children undergoing remedial operations were less likely (33%) to be cured of hypertension. There was no perioperative death or renal insufficiency requiring dialysis after either primary or secondary interventions.
Contemporary surgical treatment of pediatric RVH provides a sustainable overall benefit to 90% of children. Interventions in the very young (<3 years) and concurrent abdominal aortic coarctation increase the likelihood of reoperation. Patients undergoing remedial surgery after earlier operative failures are less likely to be cured of hypertension. Judicious postoperative surveillance is imperative in children surgically treated for RVH. |
|---|---|
| AbstractList | Renovascular hypertension (RVH) associated with renal artery and abdominal aortic narrowings is the third most common cause of pediatric hypertension. Untreated children may experience major cardiopulmonary complications, stroke, renal failure, and death. The impetus of this study was to describe the increasingly complex surgical practice for such patients with an emphasis on anatomic phenotype and contemporary outcomes after surgical management as a means of identifying those factors responsible for persistent or recurrent hypertension necessitating reoperation.BACKGROUNDRenovascular hypertension (RVH) associated with renal artery and abdominal aortic narrowings is the third most common cause of pediatric hypertension. Untreated children may experience major cardiopulmonary complications, stroke, renal failure, and death. The impetus of this study was to describe the increasingly complex surgical practice for such patients with an emphasis on anatomic phenotype and contemporary outcomes after surgical management as a means of identifying those factors responsible for persistent or recurrent hypertension necessitating reoperation.A retrospective analysis was performed of consecutive pediatric patients with RVH undergoing open surgical procedures at the University of Michigan from 1991 to 2017. Anatomic phenotype and patient risk factors were analyzed to predict outcomes of blood pressure control and the need for secondary operations using ordered and binomial logistic multinomial regression models, respectively.METHODSA retrospective analysis was performed of consecutive pediatric patients with RVH undergoing open surgical procedures at the University of Michigan from 1991 to 2017. Anatomic phenotype and patient risk factors were analyzed to predict outcomes of blood pressure control and the need for secondary operations using ordered and binomial logistic multinomial regression models, respectively.There were 169 children (76 girls, 93 boys) who underwent primary index operations at a median age of 8.3 years; 31 children (18%) had neurofibromatosis type 1, 76 (45%) had abdominal aortic coarctations, and 28 (17%) had a single functioning kidney. Before treatment at the University of Michigan, 51 children experienced failed previous open operations (15) or endovascular interventions (36) for RVH at other institutions. Primary surgical interventions (342) included main renal artery (136) and segmental renal artery (10) aortic reimplantation, renal artery bypass (55), segmental renal artery embolization (10), renal artery patch angioplasty (8), resection with reanastomosis (4), and partial or total nephrectomy (25). Non-renal artery procedures included patch aortoplasty (32), aortoaortic bypass (32), and splanchnic arterial revascularization (30). Nine patients required reoperation in the early postoperative period. During a mean follow-up of 49 months, secondary interventions were required in 35 children (21%), including both open surgical (37) and endovascular (14) interventions. Remedial intervention to preserve primary renal artery patency or a nephrectomy if such was impossible was required in 22 children (13%). The remaining secondary procedures were performed to treat previously untreated disease that became clinically evident during follow-up. Age at operation and abdominal aortic coarctation were independent predictors for reoperation. The overall experience revealed hypertension to be cured in 74 children (44%), improved in 78 (46%), and unchanged in 17 (10%). Children undergoing remedial operations were less likely (33%) to be cured of hypertension. There was no perioperative death or renal insufficiency requiring dialysis after either primary or secondary interventions.RESULTSThere were 169 children (76 girls, 93 boys) who underwent primary index operations at a median age of 8.3 years; 31 children (18%) had neurofibromatosis type 1, 76 (45%) had abdominal aortic coarctations, and 28 (17%) had a single functioning kidney. Before treatment at the University of Michigan, 51 children experienced failed previous open operations (15) or endovascular interventions (36) for RVH at other institutions. Primary surgical interventions (342) included main renal artery (136) and segmental renal artery (10) aortic reimplantation, renal artery bypass (55), segmental renal artery embolization (10), renal artery patch angioplasty (8), resection with reanastomosis (4), and partial or total nephrectomy (25). Non-renal artery procedures included patch aortoplasty (32), aortoaortic bypass (32), and splanchnic arterial revascularization (30). Nine patients required reoperation in the early postoperative period. During a mean follow-up of 49 months, secondary interventions were required in 35 children (21%), including both open surgical (37) and endovascular (14) interventions. Remedial intervention to preserve primary renal artery patency or a nephrectomy if such was impossible was required in 22 children (13%). The remaining secondary procedures were performed to treat previously untreated disease that became clinically evident during follow-up. Age at operation and abdominal aortic coarctation were independent predictors for reoperation. The overall experience revealed hypertension to be cured in 74 children (44%), improved in 78 (46%), and unchanged in 17 (10%). Children undergoing remedial operations were less likely (33%) to be cured of hypertension. There was no perioperative death or renal insufficiency requiring dialysis after either primary or secondary interventions.Contemporary surgical treatment of pediatric RVH provides a sustainable overall benefit to 90% of children. Interventions in the very young (<3 years) and concurrent abdominal aortic coarctation increase the likelihood of reoperation. Patients undergoing remedial surgery after earlier operative failures are less likely to be cured of hypertension. Judicious postoperative surveillance is imperative in children surgically treated for RVH.CONCLUSIONSContemporary surgical treatment of pediatric RVH provides a sustainable overall benefit to 90% of children. Interventions in the very young (<3 years) and concurrent abdominal aortic coarctation increase the likelihood of reoperation. Patients undergoing remedial surgery after earlier operative failures are less likely to be cured of hypertension. Judicious postoperative surveillance is imperative in children surgically treated for RVH. Renovascular hypertension (RVH) associated with renal artery and abdominal aortic narrowings is the third most common cause of pediatric hypertension. Untreated children may experience major cardiopulmonary complications, stroke, renal failure, and death. The impetus of this study was to describe the increasingly complex surgical practice for such patients with an emphasis on anatomic phenotype and contemporary outcomes after surgical management as a means of identifying those factors responsible for persistent or recurrent hypertension necessitating reoperation. A retrospective analysis was performed of consecutive pediatric patients with RVH undergoing open surgical procedures at the University of Michigan from 1991 to 2017. Anatomic phenotype and patient risk factors were analyzed to predict outcomes of blood pressure control and the need for secondary operations using ordered and binomial logistic multinomial regression models, respectively. There were 169 children (76 girls, 93 boys) who underwent primary index operations at a median age of 8.3 years; 31 children (18%) had neurofibromatosis type 1, 76 (45%) had abdominal aortic coarctations, and 28 (17%) had a single functioning kidney. Before treatment at the University of Michigan, 51 children experienced failed previous open operations (15) or endovascular interventions (36) for RVH at other institutions. Primary surgical interventions (342) included main renal artery (136) and segmental renal artery (10) aortic reimplantation, renal artery bypass (55), segmental renal artery embolization (10), renal artery patch angioplasty (8), resection with reanastomosis (4), and partial or total nephrectomy (25). Non-renal artery procedures included patch aortoplasty (32), aortoaortic bypass (32), and splanchnic arterial revascularization (30). Nine patients required reoperation in the early postoperative period. During a mean follow-up of 49 months, secondary interventions were required in 35 children (21%), including both open surgical (37) and endovascular (14) interventions. Remedial intervention to preserve primary renal artery patency or a nephrectomy if such was impossible was required in 22 children (13%). The remaining secondary procedures were performed to treat previously untreated disease that became clinically evident during follow-up. Age at operation and abdominal aortic coarctation were independent predictors for reoperation. The overall experience revealed hypertension to be cured in 74 children (44%), improved in 78 (46%), and unchanged in 17 (10%). Children undergoing remedial operations were less likely (33%) to be cured of hypertension. There was no perioperative death or renal insufficiency requiring dialysis after either primary or secondary interventions. Contemporary surgical treatment of pediatric RVH provides a sustainable overall benefit to 90% of children. Interventions in the very young (<3 years) and concurrent abdominal aortic coarctation increase the likelihood of reoperation. Patients undergoing remedial surgery after earlier operative failures are less likely to be cured of hypertension. Judicious postoperative surveillance is imperative in children surgically treated for RVH. |
| Author | Modi, Zubin J Eliason, Jonathan L Khaja, Minhaj S Beaulieu, Robert Ganesh, Santhi K Kershaw, David B Williams, David Coleman, Dawn M Jackson, Tatum Karmakar, Monita Stanley, James C |
| Author_xml | – sequence: 1 givenname: Dawn M surname: Coleman fullname: Coleman, Dawn M email: dawnbarn@med.umich.edu organization: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich. Electronic address: dawnbarn@med.umich.edu – sequence: 2 givenname: Jonathan L surname: Eliason fullname: Eliason, Jonathan L organization: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich – sequence: 3 givenname: Robert surname: Beaulieu fullname: Beaulieu, Robert organization: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich – sequence: 4 givenname: Tatum surname: Jackson fullname: Jackson, Tatum organization: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich – sequence: 5 givenname: Monita surname: Karmakar fullname: Karmakar, Monita organization: Department of Surgery, University of Michigan, Ann Arbor, Mich – sequence: 6 givenname: David B surname: Kershaw fullname: Kershaw, David B organization: Division of Pediatric Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Mich – sequence: 7 givenname: Zubin J surname: Modi fullname: Modi, Zubin J organization: Division of Pediatric Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Mich; Susan B. Meister Child Evaluation and Research Center, University of Michigan, Ann Arbor, Mich – sequence: 8 givenname: Santhi K surname: Ganesh fullname: Ganesh, Santhi K organization: Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Mich; Department of Human Genetics, University of Michigan, Ann Arbor, Mich – sequence: 9 givenname: Minhaj S surname: Khaja fullname: Khaja, Minhaj S organization: Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan, Ann Arbor, Mich – sequence: 10 givenname: David surname: Williams fullname: Williams, David organization: Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan, Ann Arbor, Mich – sequence: 11 givenname: James C surname: Stanley fullname: Stanley, James C organization: Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32276020$$D View this record in MEDLINE/PubMed |
| BookMark | eNpNkE1OwzAQhS1URH_gAGyQl2wSHCex0yWq-JOQWADryLEnxVViB9up1CtwCs7CyTClSKxmnuabJ703RxNjDSB0npE0Ixm72qSbrU8poSQlNCVFeYRmGVnyhFVkOfm3T9Hc-w0hWVZW_ARNc0o5i28z9PE8urWWosO9MGINPZiAbYsHUFoEpyV2YLRJ-r0Ghd92A7gAxmtrsAdpjRJuh4P9AaONiMeorZTd6PUWsNIehAcsjMKiUbbXe8y6oOXXp7TCySBCdDtFx63oPJwd5gK93t68rO6Tx6e7h9X1YyLLkoWkYQVQaPNWNUVOOKM5V5xCUfKmVC1kgsisJKTirCmZkgCc5LxlgrGCyNgFXaDLX9_B2fcRfKh77SV0nTBgR1_TvKoqymlRRPTigI5NbKAenO5j2vqvP_oNl_B5Ag |
| CitedBy_id | crossref_primary_10_1177_17085381211059664 crossref_primary_10_1007_s00467_021_05063_2 crossref_primary_10_1093_hmg_ddab241 crossref_primary_10_1007_s00431_022_04550_4 crossref_primary_10_1016_j_jpurol_2021_06_026 crossref_primary_10_1016_j_jvs_2022_02_033 crossref_primary_10_1161_HYP_0000000000000217 crossref_primary_10_1016_j_ejvs_2023_07_049 crossref_primary_10_1111_nep_14262 crossref_primary_10_1007_s00467_021_05152_2 crossref_primary_10_1016_j_jvs_2020_10_017 crossref_primary_10_1053_j_semvascsurg_2021_02_009 crossref_primary_10_1007_s11906_021_01136_7 crossref_primary_10_1016_j_jvs_2022_01_121 crossref_primary_10_1016_j_jvir_2024_03_011 crossref_primary_10_1016_j_jvs_2020_12_053 crossref_primary_10_1016_j_jvir_2021_12_002 crossref_primary_10_1016_j_suc_2023_05_007 crossref_primary_10_1186_s13256_025_05208_z |
| ContentType | Journal Article |
| Copyright | Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. |
| Copyright_xml | – notice: Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. |
| CorporateAuthor | University of Michigan Pediatric Renovascular Hypertension Center |
| CorporateAuthor_xml | – name: University of Michigan Pediatric Renovascular Hypertension Center |
| DBID | CGR CUY CVF ECM EIF NPM 7X8 |
| DOI | 10.1016/j.jvs.2020.02.045 |
| DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic |
| DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic |
| DatabaseTitleList | MEDLINE - Academic MEDLINE |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | no_fulltext_linktorsrc |
| Discipline | Medicine |
| EISSN | 1097-6809 |
| ExternalDocumentID | 32276020 |
| Genre | Research Support, Non-U.S. Gov't Journal Article Research Support, N.I.H., Extramural |
| GrantInformation_xml | – fundername: NHLBI NIH HHS grantid: R01 HL139672 |
| GroupedDBID | --- --K .1- .55 .FO .GJ .XZ 0R~ 1B1 1P~ 1~5 2WC 354 4.4 457 4G. 53G 5GY 5RE 5VS 7-5 AACTN AAEDT AAEDW AAIKJ AALRI AAQFI AAQXK AAXUO ABFRF ABJNI ABLJU ABMAC ABOCM ABWVN ACGFO ACGFS ACPHU ACRPL ADBBV ADEZE ADMUD ADNMO ADVLN AEFWE AENEX AEVXI AEXQZ AFCTW AFFNX AFJKZ AFRHN AFTJW AGHFR AITUG AJUYK AKRWK ALMA_UNASSIGNED_HOLDINGS AMRAJ ASPBG AVWKF AZFZN BAWUL BELOY C45 C5W CAG CGR COF CS3 CUY CVF DIK DU5 E3Z EBS ECM EFJIC EIF EJD FDB FEDTE FGOYB FRP GBLVA HVGLF HZ~ IHE IXB J1W J5H K-O KOM L7B M41 MO0 N4W NPM NQ- O-L O9- OB2 OBH OHH OK- OK1 OVD OW- OZT P2P R2- RIG ROL RPZ SDG SDP SEL SES SEW SJN SSZ TEORI UHS UV1 VVN W2D X7M XH2 YFH YOC Z5R ZGI ZXP ZY1 7X8 AAYWO ACVFH ADCNI AEUPX AFPUW AIGII AKBMS AKYEP APXCP EFKBS |
| ID | FETCH-LOGICAL-c556t-b64e2ef3fdb43076237d72e457b5dfe1a0c1500876b56dcee7037f6a6640c8092 |
| IEDL.DBID | 7X8 |
| ISICitedReferencesCount | 23 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000599633900027&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 1097-6809 |
| IngestDate | Sun Nov 09 11:21:48 EST 2025 Thu Apr 03 07:04:26 EDT 2025 |
| IsDoiOpenAccess | false |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 6 |
| Keywords | Aortic coarctation Renal artery stenosis Renovascular hypertension pediatric |
| Language | English |
| License | Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c556t-b64e2ef3fdb43076237d72e457b5dfe1a0c1500876b56dcee7037f6a6640c8092 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| OpenAccessLink | https://www.ncbi.nlm.nih.gov/pmc/articles/7541589 |
| PMID | 32276020 |
| PQID | 2388827244 |
| PQPubID | 23479 |
| ParticipantIDs | proquest_miscellaneous_2388827244 pubmed_primary_32276020 |
| PublicationCentury | 2000 |
| PublicationDate | 2020-12-01 |
| PublicationDateYYYYMMDD | 2020-12-01 |
| PublicationDate_xml | – month: 12 year: 2020 text: 2020-12-01 day: 01 |
| PublicationDecade | 2020 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States |
| PublicationTitle | Journal of vascular surgery |
| PublicationTitleAlternate | J Vasc Surg |
| PublicationYear | 2020 |
| SSID | ssj0011587 |
| Score | 2.4558127 |
| Snippet | Renovascular hypertension (RVH) associated with renal artery and abdominal aortic narrowings is the third most common cause of pediatric hypertension.... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| StartPage | 2035 |
| SubjectTerms | Adolescent Age Factors Antihypertensive Agents - therapeutic use Aorta, Abdominal - abnormalities Aorta, Abdominal - diagnostic imaging Aorta, Abdominal - physiopathology Aorta, Abdominal - surgery Aortic Coarctation - complications Aortic Coarctation - diagnostic imaging Aortic Coarctation - physiopathology Aortic Coarctation - surgery Blood Pressure Child Child, Preschool Female Humans Hypertension, Renovascular - diagnosis Hypertension, Renovascular - etiology Hypertension, Renovascular - physiopathology Hypertension, Renovascular - surgery Male Renal Artery Obstruction - complications Renal Artery Obstruction - diagnostic imaging Renal Artery Obstruction - physiopathology Renal Artery Obstruction - surgery Retrospective Studies Treatment Outcome Vascular Surgical Procedures - adverse effects |
| Title | Surgical management of pediatric renin-mediated hypertension secondary to renal artery occlusive disease and abdominal aortic coarctation |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/32276020 https://www.proquest.com/docview/2388827244 |
| Volume | 72 |
| WOSCitedRecordID | wos000599633900027&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1LSwMxEA5qRbz4ftQXEbwG95WkexIRi5eWggq9LZsXKrqpu22hP8F_7SS7a0-C4GVP2RCSycyXfF9mELoKqGKhoZKIWGg4oFBNRGQ0oVrIhKuYGpX7YhN8OOyNx-mouXCrGlll6xO9o1ZWujvyawgtAAY5RKObySdxVaMcu9qU0FhFnRigjJN08fGSRQipL5DnSFbCekHasppe3_U2d9m6o8Cn7Ezo7wjTR5r-9n_HuIO2GoyJb2uj2EUruthDG4OGRd9HX4-z0js8_PEjfsHW4ElbtgM7CV5B_KsSQKT4BQ6rpZe62wJX7git8nKBp9Y1hG68LnSBrZTvMyeHxw3tg_NC4Vwo6yuH4dy6EWFpYXPVCoAD9Ny_f7p7IE1JBiIpZVMiWKIjbWKjRALeAbATVzzSCeWCKqPDPJCAMF2aO0GZggAMDoUbljOWBBJWIDpEa4Ut9DHCITRPk1RzmqbQaSyiSBkjIwMuRNAe66LLdpIzMHnHY-SFtrMqW05zFx3VK5VN6twcGfgnzmBVT_7w9ynadAZQi1POUMfAhtfnaF3Op69VeeFtCb7D0eAbeePXvQ |
| linkProvider | ProQuest |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Surgical+management+of+pediatric+renin-mediated+hypertension+secondary+to+renal+artery+occlusive+disease+and+abdominal+aortic+coarctation&rft.jtitle=Journal+of+vascular+surgery&rft.au=Coleman%2C+Dawn+M&rft.au=Eliason%2C+Jonathan+L&rft.au=Beaulieu%2C+Robert&rft.au=Jackson%2C+Tatum&rft.date=2020-12-01&rft.issn=1097-6809&rft.eissn=1097-6809&rft.volume=72&rft.issue=6&rft.spage=2035&rft_id=info:doi/10.1016%2Fj.jvs.2020.02.045&rft.externalDBID=NO_FULL_TEXT |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1097-6809&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1097-6809&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1097-6809&client=summon |