Endovascular treatment of transplant renal artery stenosis based on hemodynamic assessment using a pressure wire: a case report

Kadoya, Y.; Zen, Kan; Matoba, Satoaki

doi:10.1186/s12872-018-0909-y

Cited by 8 publications

(7 citation statements)

References 13 publications

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“…TRAS is a common vascular complication after renal transplantation and is an important factor leading to renal failure and postoperative hypertension [1][2][3]. According to reports, the incidence of TRAS varies greatly depending on the diagnostic method, ranging from 1% to 23% [4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…Transplant renal artery stenosis (TRAS) severely affects hemodynamics of the grafted kidney. It can cause refractory hypertension and renal dysfunction, and can even progress to graft failure, which ultimately may reduce the survival rate of grafted kidneys [1][2][3]. The incidence of TRAS varies greatly depending on the diagnostic method used, ranging from 1% to 23% [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis and Treatment of Renal Artery Stenosis in China in the Era of Donation After Cardiac Death

Wang

Liu

et al. 2020

Ann Transplant

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The aim of this study was to investigate the clinical features and treatment strategies of transplant renal artery stenosis (TRAS) with kidneys from donation after cardiac death (DCD). Material/Methods:We collected the clinical data of donors and recipients of single-center DCD-induced TRAS from January 2015 to June 2017. Results:All the 8 cases of TRAS were from hypertensive cerebrovascular accident DCD-originated kidneys. The mean donor age was 53.5 (45~57) years, with mean BMI 27.8 (26.4~32.3) kg/m 2 , atherosclerosis index 5.8 (4.9~7.0), and renal atherosclerotic plaque. Clinical features of TRAS were: refractory hypertension with elevated serum creatinine >50%, and negative urine protein and occult blood. Ultrasound of transplanted kidneys showed renal blood flow index 0.49 (0.43~0.55). Angiography confirmed the diagnosis of renal artery trunk or secondary branch stenosis. There were 2 cases of moderate stenosis and 6 cases of severe stenosis. Six patients underwent stent implantation and 2 patients underwent balloon dilatation. Seven patients had serum creatinine recovery after interventional therapy during follow-up. The transplanted kidney of 1 patient ruptured 6 h after interventional therapy and was then resected. Conclusions:The incidence of TRAS with hypertensive cerebrovascular accident DCD-originated kidneys is relatively high, which is a warning to kidney transplant physicians. Digital subtraction angiography (DSA) is the most reliable diagnostic means of TRAS and can be performed concurrently with intervention therapy. If the donor has severe atherosclerosis, plaques that are visible to the unaided eye in the renal artery trunk should be removed as completely as possible.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnosis and Treatment of Renal Artery Stenosis in China in the Era of Donation After Cardiac Death

Wang

Liu

et al. 2020

Ann Transplant

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“…TRAS is an important cause of poor long-term prognosis and low survival rate of kidney transplantation [ 5 ]. Its clinical manifestations are atypical and mainly include refractory hypertension and graft dysfunction, or it is asymptomatic [ 1 ]. The incidence of TRAS is 1 to 23% [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Transplant renal artery stenosis (TRAS) is a serious vascular complication that occurs after renal transplantation, and it can result in hypertension, renal functional impairment, and graft loss [ 1 ]. The incidence of TRAS is approximately 1 to 23% [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Spontaneous recanalization of occluded transplant renal artery: a rare case report

et al. 2020

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Background Transplant renal artery stenosis (TRAS) is a serious vascular complication that occurs after renal transplantation and can result in hypertension, renal functional impairment, and graft loss. Endovascular treatment has become the first-line treatment for TRAS because of its low invasiveness and high success rate. Case presentation A 23-year-old female with end-stage renal disease of unknown cause received a living-donor kidney transplantation 10 months ago. Seven months after the transplantation, her blood pressure gradually deteriorated. Magnetic resonance angiography revealed bending and stenosis of the transplant renal artery, and the patient received endovascular treatment. A digital subtraction angiography revealed significant stenosis of 95% in the proximal transplant renal artery. The guidewire could not pass through the stenotic segment of the transplant renal artery even with repeated attempts by the surgeons; as a result, the transplant renal artery became occluded, and vasodilators were ineffective. After the operation, renal function gradually worsened, so she began to receive regular dialysis. Twenty-five days later, the patient’s urine volume was significantly higher than that before, and ultrasound showed that the proximal transplant renal artery was not completely occluded. A re-intervention was performed, and the stent was placed successfully in the stenotic segment. After the operation, renal function gradually recovered, and dialysis was no longer needed. Conclusion Patients with iatrogenic transplant renal artery occlusion may have the possibility of spontaneous recanalization, which can help prevent the need for re-transplantation.

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“…A growing interest in anatomical variants of renal arteries is not surprising [1–4] considering a progress in kidney surgeries which are performed in the treatment of resistant hypertension and abdominal aortic aneurysms, or as transplantation procedures [5–7]. Modern imaging techniques can provide a detailed and highly accurate information about arterial supply of the kidneys.…”

Section: Introductionmentioning

confidence: 99%

Renal-aortic ratio as an objective measure of renal artery diameter a computed tomography angiography study

Majos

Polguj

Stefańczyk

et al. 2019

BMC Cardiovasc Disord

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Background Considering vital role of renal arteries in many surgical procedures, diameter of renal arteries seems to be an important measure of kidney perfusion. In this study, we analyzed a new parameter, renal-aortic ratio (R-Ar) as an objective measure of the renal artery diameter. Method The study included CT angiographic images from 254 patients (129 women and 125 men). R-Ar was calculated by dividing the diameter of the main renal artery for each kidney by the aortic diameter. Results R-Ar values for the whole study group ranged between 0.0863 and 0.5083; the ranges of R-Ar values for women and men patients were 0.1150–0.5083 and 0.0863–0.4449, respectively. In 412 cases (81.10%), the kidney was supplied by a single renal artery (RA variant) and in 96 (18.90%) by more than one artery (sRA variant). A significant difference was found in R-Ar values for RA and sRA variants ( p = 0.0008). When the anatomical variant of renal perfusion was not considered on statistical analysis, a significant difference was found between the R-Ar values for women and men ( p = 0.0259). No statistically significant difference was observed in R-Ar values for the right and left kidneys ( p = 0.3123). Spearman’s coefficient of rank correlation between patient age and renal-aortic ratio values for the whole study group equaled − 0.36. Conclusion The analysis of the renal-aortic ratio values demonstrated that the diameter of renal arteries depended primarily on their number, and the relative diameter of renal arteries in women was larger than in men.

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Endovascular treatment of transplant renal artery stenosis based on hemodynamic assessment using a pressure wire: a case report

Cited by 8 publications

References 13 publications

Diagnosis and Treatment of Renal Artery Stenosis in China in the Era of Donation After Cardiac Death

Diagnosis and Treatment of Renal Artery Stenosis in China in the Era of Donation After Cardiac Death

Spontaneous recanalization of occluded transplant renal artery: a rare case report

Renal-aortic ratio as an objective measure of renal artery diameter a computed tomography angiography study

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