transplant renal artery stenosis. Poster No.: C-0982. Congress: ECR 2013. Type: Scientific Exhibit. Authors: C. Vergadis, P. Leonardou, E. Spathi, P. Pappas; ...
Percutaneous transluminal angioplasty and stenting in transplant renal artery stenosis Poster No.:
C-0982
Congress:
ECR 2013
Type:
Scientific Exhibit
Authors:
C. Vergadis, P. Leonardou, E. Spathi, P. Pappas; P.Penteli/GR
Keywords:
Interventional vascular, Catheter arteriography, Angioplasty, Transplantation
DOI:
10.1594/ecr2013/C-0982
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Purpose To evaluate the efficacy of percutaneous angioplasty and stenting in cases of artery stenosis of the transplanted kidney or proximal iliac artery stenosis causing transplant dysfunction and/or increase of the arterial blood pressure.
Methods and Materials Between 2000 and 2011, we evaluated 30 patients (14 men and 16 women, aged between 26 to 66 years old [mean 47 years]) who had undergone renal transplantation. Also they subsequently were diagnosed with refractory hypertension and transplant dysfunction for signs of possible renal transplant artery stenosis. Color Doppler ultrasonography and magnetic resonance angiography was performed prior to intrarterial angiographic investigation. In 2 of the 30 patients, arterial angiography did not reveal arterial stenosis affecting the transplanted kidney even though there was a strong clinical suspicion. 3 patients had severe ipsilateral iliac artery stenosis and the remaining 25 had transplant artery stenosis. Successful angioplasty and stenting were performed in these 28 patients immediately after the intrarterial angiography (fig.1). At the most of them 4- to 6-mm diameter and 12- to 20-mm length, balloon expandable stents inserted (fig.2), (fig.3), whereas the two iliac arteries each received one 8-mm diameter, 40-mm length, balloon expandable stent (fig.4). Images for this section:
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Fig. 1: (A)Intraarterial DSA depicts transplant renal artery stenosis (B)Post percutaneus angioplasty and stenting image
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Fig. 2: IA DSA depicts transplant renal artery stenosis.
Fig. 3: Postpercutaneous transluminal angioplasty and stenting image.
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Fig. 4: (A)Intraarterial DSA image depicts stenosis of the left common iliac artery proximal to the transplant renal artery (B)Post percutaneus angioplasty and stenting image. No residual stenosis obtained.
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Results The method was technically feasible in 100% (30/30). No major or minor complications related to the procedure noted. During the followup period (mean 75 months), 4 patients died with acceptable transplant function, 3 suffered transplant failure, and the remaining 23 still have normal transplant function and easily controlled hypertension.
Conclusion Percutaneous angioplasty and stenting in cases of arterial stenosis affecting the renal transplant function are safe and effective procedure. The referred complications of PTAS in the literature are dissection of renal artery, dislocation of stent, embolization of the renal parenchyma, and hematoma at the femoral puncture site or pseudoaneurysm formation. We had no such complication in our files. Even more, the strong clinical suspicion must lead to angiographic investigation regardless of the results of other imaging approaches.
References 1. 2. 3.
4.
5.
6. 7.
8.
Lacombe M: Arterial stenosis complicating renal allotransplantation in man. Ann Surg 181:283, 1975 Fervenza FC, Lafayette RA, Alfrey EJ, et al: Renal artery stenosis in kidney transplants. Am J Kidney Dis 31:142, 1998 Smellie WA, Vinik M, Hume DM: Angiographic investigation of hypertension complicating human renal transplantation. SurgGynecol Obstet 128:963, 1969 Becker BN, Odorico JS, Becker YT, et al: Peripheral vascular disease and renal transplant artery stenosis: a reappraisal of transplant renovascular disease. Clin Transplant 13:349, 1999 Rengel M, Gomes-Da-Silva G, Inchaustegui L, et al: Renal artery stenosis after kidney transplantation: diagnostic and therapeutic approach. Kidney Int Suppl 68:S99, 1998 Gray DW: Graft renal artery stenosis in the transplanted kidney. Transplant Rev 8:15, 1994 Becker BN, Odorico JS, Becker YT, et al: Peripheral vascular disease and renal transplant artery stenosis: a reappraisal of transplant renovascular disease. Clin Transplant 13:349, 1999 Alfrey EJ, Smythe R, Friedman A, et al: Two masqueraders of transplant renal artery stenosis (TRAS). Clin Transpl 7:183, 1993 Page 7 of 8
9.
10.
11. 12.
13.
14. 15. 16. 17. 18. 19.
20.
21. 22. 23.
Aslam S, Salifu MO, Ghali H, et al: Common iliac artery stenosis presenting as renal allograft dysfunction in two diabetic recipients. Transplantation 71:814, 2001 Erley CM, Duda SH, Wakat J-P, et al: Noninvasive procedures for diagnosis of renovascular hypertension in renal transplant recipients: a prospective analysis. Transplantation 54:863, 1992 Loubeyre P, Abidi H, Cahen R, et al: Transplant kidney renal artery: detection of stenosis with color Doppler US. Radiology 203:661, 1997 14. Mell MW, Alfrey EJ, Rubin GD, et al: Use of spiral computed tomography in the diagnosis of transplant renal artery stenosis. Transplantation 57:746, 1994 Vasbinder GBC, Nelemans PJ, Kessels AGH, et al: Diagnostic tests for renal artery stenosis in patients suspected of having renovascular hypertension: a meta-analysis. Ann Intern Med 135:401, 2001 Thomsen HS: How to avoid CIN: guidelines from the European Society of Urogenital Radiology. Nephrol Dial Transplant 20(suppl 1):i18, 2005 Gedroyc WM, Reidy JF, Saxton HM: Arteriography of renal transplantation. Clin Radiol 38:239, 1987 Benoit G, Hiesse C, Icard P, et al: Treatment of renal artery stenosis after renal transplantation. Transplant Proc 19:3600, 1987 Greenstein S, Verstanding A, McLean G, et al: Percutaneous transluminal angioplasty. Transplantation 43:29, 1987 Roberts JP, Ascher NL, Fryd DS, et al: Transplant renal artery stenosis. Transplantation 48:580, 1989 Raynaud A, Bedrossian J, Remy P, et al: Percutaneous transluminal angioplasty of renal transplant renal arterial stenosis. AJR Am J Roentgenol 146:853, 1986 Leertouwer TC, Gussenhoven EJ, Bosch 0JL, et al: Stent placement for renal arterial stenosis: where do we stand? A meta-analysis. Radiology 216:78, 2000 Spinosa DJ, Isaacs RB, Matsumoto AH, et al: Angiographic evaluation and treatment of transplant renal artery stenosis. CurOpin Urol 11:197, 2001 Beecroft JR, Rajan DK, Clark TW, et al: Transplant renal artery stenosis: outcome after percutaneous intervention. J VascInterv Radiol 15:1407, 2004 Voiculescu A, Schmitz M, Hollenbeck M, et al: Management of arterial stenosis affecting kidney graft perfusion: a single-centre study in 53 patients. Am J Transplant 5:1731, 2005
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