Evaluation of the inferior vena cava in potential pediatric renal transplant recipients

Abstract

Vascular anomalies due to occlusion or thrombosis of the inferior vena cava (IVC) may be hazardous to renal transplantation, and preoperative vascular evaluation is important for safe and successful surgery. The purpose of this study was to assess the utility and accuracy of two-dimensional time-of-flight (2D-TOF) magnetic resonance venography (MRV) as an alternative to conventional angiography for evaluating the IVC and iliac vein in potential pediatric renal transplant recipients. Four children with chronic renal failure were evaluated with 2D-TOF MRV by superior presaturation pulse and target maximum intensity projection. The whole MRV examination and filming required less than 30 min. All four patients had a normal IVC and iliac vein. Two of the patients underwent renal transplantation, and the MRV findings were in total agreement with the final anatomy revealed intraoperatively. MRV is accurate for evaluating the condition of the IVC and iliac vein. It is a reliable, noninvasive and rapid technique that can be considered as an alternative to invasive angiography for evaluation of children scheduled for transplantation. We recommend the use of this noninvasive procedure to ascertain the patency of the IVC in all infants and children with a history of indwelling catheters in the IVC or those with a propensity to thrombosis, i.e., all recipients with nephrotic syndrome. The insertion of catheters in the femoral vein in children who may become candidates for renal transplantation should be discouraged.

What is the value of magnetic resonance venography in children before renal transplantation?

“…In a recent report of four patients undergoing RTx who had MRV correctly delineating the anatomy as a preoperative investigation, MRV was a reasonable alternative to contrast venography. There is convincing evidence in the literature that MRV may be as accurate as contrast venography [4,[8][9][10]. MRV has the added benefit of offering additional anatomical detail in addition to avoiding nephrotoxic iodinated contrast used in venography.…”

“…There is increasing literature advocating investigations before RTx [2,4,5,7], although it is still unclear which patients should be investigated and what imaging techniques should be used. Following, we discuss the incidence and risk factors of venous thrombosis and the different imaging modalities available.…”

“…Some children with chronic kidney disease (CKD) and endstage renal failure (ESRF) are at a higher risk of thrombosis of iliac veins (IV) and inferior vena cava (IVC) [1][2][3][4]. Therefore, radiological evaluation before renal transplantation (RTx) plays an important role in operative planning, as scarring and narrowing of vessels (IVC and/or IV) can make surgery technically challenging [3][4][5][6][7].…”

“…Therefore, radiological evaluation before renal transplantation (RTx) plays an important role in operative planning, as scarring and narrowing of vessels (IVC and/or IV) can make surgery technically challenging [3][4][5][6][7]. Many children with venous thrombosis do not have symptoms or clinical signs owing to extensive venous collateral flow [7].…”

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“…[2][3][4] This procedure can allow clear discussion of the venous anastomosis site [5][6][7][8][9][10][11][12][13][14] and the necessity of a venous graft [5][6][7][8][9][10][11][12]13 before transplant surgery.…”