Interventional Radiologic Management of Renal Transplant Dysfunction: Indications, Limitations, and Technical Considerations

Kobayashi, Katsuhiro; Censullo, Michael L.; Rossman, Lucho L.; Kyriakides, Polina N.; Kahan, Barry D.; Cohen, Alan M.

doi:10.1148/rg.274065135

Cited by 137 publications

(81 citation statements)

References 60 publications

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“…When the PA becomes larger and blood leakage occurs into the collecting system, macroscopic hematuria may occur (26). In the literature, macroscopic hematuria and/or flank pain were reported in almost all cases with PA (25,27). In line with previously reported studies, all patients were symptomatic in the present series.…”

Section: Discussionsupporting

confidence: 88%

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Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

Güneyli¹,

Gök²,

Bozkaya³

et al. 2015

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to evaluate iatrogenic renal arterial lesions, including pseudoaneurysm, arteriovenous fistula, and arteriocaliceal fistula, their management by endovascular embolization, and the clinical results. METHODSFifty-five patients (forty males, fifteen females) with a median age of 40 years (range, 8-85 years), who underwent endovascular embolization of iatrogenic renal arterial lesions between March 2003 and December 2013 were included in this retrospective study. Types of iatrogenic lesions and details of embolization procedures were reported. Estimated glomerular filtration rate (eGFR), renal function tests, hemoglobin, and hematocrit levels before and after embolization were recorded and compared. RESULTSMedian follow-up was 24 months. We identified 53 pseudoaneurysms, 30 arteriovenous fistulas, and 11 arteriocaliceal fistulas in 55 patients, after percutaneous nephrolithotomy (n=26), renal biopsy (n=21), nephrostomy (n=3), renal surgery (n=3), and extracorporeal shock wave lithotripsy (n=2). Median number of pseudoaneurysms was 1 (range, 1-4) with a median size of 7 mm (range, 1.5-35 mm). Fifty-one patients underwent coil embolization. Median number of coils was 5 (range, 2-21) and median renal parenchymal loss was 5% (range, 1%-50%). There were no significant differences between pre-and postoperative eGFR and serum parameters. CONCLUSION Iatrogenic renal arterial lesion can be a life threatening condition. Superselective coil embolization is a safe, minimally invasive treatment option with minimal renal parenchymal loss and without significant change in renal function. Iatrogenic renal arterial lesions including pseudoaneurysm (PA), arteriovenous fistula (AVF), and arteriocaliceal fistula (ACF) are rare, but life-threatening conditions (1). The chief symptom usually includes macroscopic hematuria (2, 3). Catheter angiography is the gold standard for both diagnosis and treatment (1).Previous studies have evaluated the iatrogenic renal arterial lesions following partial nephrectomy (1, 3-7), but there were only a few studies on iatrogenic renal arterial lesions following any iatrogenic renal interventions (2). In the present study, to the best of our knowledge, we report the largest series of iatrogenic renal arterial lesions following various renal interventions such as biopsy, percutaneous nephrolithotomy (PCNL), percutaneous nephrostomy, and partial nephrectomy. We focused on clinical presentations, imaging findings, management, and outcomes. Methods PatientsData regarding iatrogenic renal arterial lesions treated by endovascular embolization performed at our institution between March 2003 and December 2013 were evaluated retrospectively. A total of 55 patients with iatrogenic renal arterial lesions, who underwent endovascular embolization were included in the study. There were 40 males and 15 females with a median age of 40 years (range, 8-85 years). Patients with traumatic renal arterial lesions treated with endovascular embolization were excluded from the study. Informed con...

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Section: Discussionsupporting

confidence: 88%

“…AVF may be asymptom- atic, but may cause macroscopic hematuria, hypertension or cardiac failure (in rare cases), and renal transplant dysfunction due to "intrarenal steal phenomenon" (27). The frequency of simultaneous PA and AVF is unknown, yet.…”

Section: Discussionmentioning

confidence: 99%

Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

Güneyli¹,

Gök²,

Bozkaya³

et al. 2015

Diagn Interv Radiol

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“…Despite surgical and medical advances, vascular complications are still among the major concerns faced after renal transplant (RT), with a reported incidence of 3% to 15%. 1 Prophylactic correction during preoperative evaluation can obviate many problems; however, technical mishaps should be prevented at all stages of the transplant process, and careful postoperative monitoring is warranted. To minimize mortality and morbidity, all complications must be diagnosed early and managed appropriately.…”

Section: Introductionmentioning

confidence: 99%

Untitled

Soy

Akdur²,

Kırnap³

et al. 2017

Exp Clin Transplant

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Objectives: Despite surgical and medical advances, vascular complications are still among the major concerns after renal transplant, with a reported incidence of 3% to 15%. We evaluated the incidence and management of our transplant team's vascular complications over 40 years. Materials and Methods:From November 1975 to the present, we have performed a total of 2594 renal transplant procedures. Of these, 1997 grafts (76%) were obtained from living donors, and 597 grafts (24%) were obtained from deceased donors. All renal transplant procedures, including those performed in pediatric patients, used the extraperitoneal approach to the contralateral iliac fossa. Revascularization was performed for all grafts. A single end-to-end internal iliac artery anastomosis was performed in 1082 patients (41.8%), an end-to-side external iliac artery anastomosis was performed in 1289 patients (49.7%), and an end-to-side common iliac artery anastomosis was performed in 66 patients (2.5%). In 157 procedures (6%), there were at least 2 renal arteries, and both internal iliac arteries or external iliac arteries were used for anastomosis. Results: We observed 57 vascular complications (2.1%) in 54 renal transplant procedures. The most frequent complication was renal artery stenosis (n = 17; 0.6%). There were 8 instances of renal artery thrombosis (0.4%), 7 of renal artery kinking (0.3%), 5 of renal vein thrombosis (0.2%), 9 of renal vein kinking (0.5%), 3 of external iliac artery dissection (0.01%), 5 renal vein lacerations (0.2%), and 3 renal artery lacerations (0.01%). We performed urgent surgery for 41 vascular complications; 38 were managed successfully.Percutaneous interventional techniques were used successfully for 18 vascular complications. Conclusions: The vascular complication rate in our patients is lower than that reported in the literature. Surgical complications can be minimized with careful transplant technique and close follow-up, as early diagnosis is crucial to early management and successful treatment of complications.

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“…Vascular complications account for 3%-15% of all cases [2]. These include thrombosis or stenosis of the renal artery or vein.…”

Section: Introductionmentioning

confidence: 99%

Outcomes and Surgical Complications in Kidney Transplantation

Reyna-Sepúlveda¹

2016

J Transplant Res

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Interventional Radiologic Management of Renal Transplant Dysfunction: Indications, Limitations, and Technical Considerations

Cited by 137 publications

References 60 publications

Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

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Outcomes and Surgical Complications in Kidney Transplantation

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