Close to Transplant Renal Artery Stenosis and Percutaneous Transluminal Treatment

Abstract

Purpose. To evaluate the efficacy of percutaneous transluminal angioplasty (PTA) in the management of arterial stenosis located close to the allograft anastomosis (close-TRAS). Materials and Methods. 31 patients with renal transplants were admitted to our institution because of persistent hypertension and impairment of transplant renal function and underwent angiography for vascular investigation. 27 were diagnosed suffering from transplant renal artery stenosis (TRAS), whereas 4 had severe iliac artery stenosis proximal to the transplant anastomosis (Prox-TRAS). 3 cases of TRAS coexisted with segmental renal arterial stenosis, whereas 3 other cases of TRAS were caused by kinking and focal stenosis in the middle of the transplanted renal artery. Results. Angioplasty and stenting were successfully applied to all patients with iliac artery stenosis as well as to those with TRAS and segmental artery stenosis. Two of three patients with kinking were well treated with angioplasty and stenting, whereas one treated only with angioplasty necessitated surgery. No major procedure-related complications appeared, and the result was decrease of the serum creatinine level and of the blood pressure. Conclusions. PTA is the appropriate initial treatment of TRAS and close-TRAS, with low morbidity and mortality rates, achieving improvement of graft function and amelioration of hypertension.

Tailoring the Endovascular Management of Transplant Renal Artery Stenosis

“…Several studies have highlighted the importance of considering TRAS as a spectrum involving varying degrees of anatomical stenosis, atherosclerotic stenosis and immunological stenosis (immune modulating vascular injury and intimal hyperplasia) (1,3,25). Classifying TRAS into anastomotic, bend-kink and postanastomotic subtypes can aid in characterizing its underlying disease components.…”

“…A multitude of studies have made the importance of avoiding the management of TRAS as a single entity abundantly clear (1,3,6,10,25). Accordingly, these studies have employed different metrics and grading systems as a means to classify TRAS to better aid in its diagnosis and management.…”

A Systematic Review of Outcomes Following Percutaneous Transluminal Angioplasty and Stenting in the Treatment of Transplant Renal Artery Stenosis

“…Eleven studies included patients following stenting alone (n = 201) [1,2,6,[14][15][16][17][18][19][20][21]. Twelve studies involved patients receiving either PTA alone or stenting with pre balloon dilatation (n = 407, of which PTA alone = 271, stent following PTA = 89, and PTA and/or stent following PTA not discriminated in a single intervention arm = 47) [3,5,[22][23][24][25][26][27][28][29][30][31].…”

“…Doppler ultrasound was used as the sole modality in assessing for TRAS in seven studies [1,3,5,16,17,19,20], and in combination with DSA in ten studies [2,7,11,[23][24][25][26][27][28]32]. A combination of Doppler ultrasound, MRA and DSA were used in six studies [10,15,18,22,30,31].…”

Percutaneous transluminal angioplasty for dysfunctional femoral hemodialysis graft

“…PTA was performed when there was >70% narrowing of the lumen compared to baseline (8) or in the presence of a clinical dysfunction, such as high pressure of the AV graft, and unstoppable bleeding. If the AV graft was thrombosed, thrombolysis using urokinase and/or mechanical thrombolysis were used for declotting without fistulography (7).…”