Evaluation of the efficacy and safety of endovascular management for transplant renal artery stenosis

Abstract

OBJECTIVES:To evaluate the safety and efficacy of endovascular intervention with angioplasty and stent placement in patients with transplant renal artery stenosis.METHODS:All patients diagnosed with transplant renal artery stenosis and graft dysfunction or resistant systemic hypertension who underwent endovascular treatment with stenting from February 2011 to April 2016 were included in this study. The primary endpoint was clinical success, and the secondary endpoints were technical success, complication rate and stent patency.RESULTS:Twenty-four patients with transplant renal artery stenosis underwent endovascular treatment, and three of them required reinterventions, resulting in a total of 27 procedures. The clinical success rate was 100%. All graft dysfunction patients showed decreased serum creatinine levels and improved estimated glomerular filtration rates and creatinine levels. Patients with high blood pressure also showed improved control of systemic blood pressure and decreased use of antihypertensive drugs. The technical success rate of the procedure was 97%. Primary patency and assisted primary patency rates at one year were 90.5% and 100%, respectively. The mean follow-up time of patients was 794.04 days after angioplasty.CONCLUSION:Angioplasty with stent placement for the treatment of transplant renal artery stenosis is a safe and effective technique with good results in both the short and long term.

Endovascular management of transplant renal artery stenosis: A single‐center retrospective study

“…In our study, 72.7% of patients had graft dysfunction and 81.8% had refractory hypertension. These findings are consistent with previously published studies . Currently, TRAS is diagnosed mainly through the following methods: digital subtraction angiography (DSA), CDU, CTA, and MRA.…”

“…In our study, postoperative blood pressure and serum creatinine decreased significantly, and interventional therapy had good long-term effects, which may be due to the fact that most patients in this study were suffering from acute or novel hypertension caused by graft artery stenosis and the sharp decline of allograft function. Therefore, similar to other studies, 28,30 patients in this study received interventional therapy and the graft artery stenosis was relieved, resulting in significant improvement in blood pressure and graft function.…”

“…These findings are consistent with previously published studies. 28,30 Currently, TRAS is diagnosed mainly through the following methods: digital subtraction angiography (DSA), CDU, CTA, and MRA. DSA is still the gold standard for the diagnosis of TRAS.…”

“…A systematic review reported a total of 75 postoperative complications from 26 studies, concluding that the incidence of complications was 9.9%. A study conducted by Valle et al reported a case of dissection of the common iliac artery after the intervention, with a complication rate of 4% (1/24). In our cohort, no serious complications were found.…”

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

“…The incidence of TRAS is approximately 1 to 23% [ 2 ]. Endovascular treatment has become the first-line therapy for TRAS because of its low invasiveness and high success rate [ 3 , 4 ]. Herein, we report a case of TRAS in which the stenotic segment was iatrogenically occluded on the first endovascular treatment attempt, followed by subsequent spontaneous recanalization and successful stent placement.…”