Transluminal Angioplasty of Transplanted Renal Artery Stenosis: A Review of the Literature for Its Safety and Efficacy

Leonardou, Polytimi; Gioldasi, Sofia; Pappas, Paris

doi:10.1155/2011/693820

Cited by 14 publications

(14 citation statements)

References 19 publications

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“…Generally a reduction in the diameter of the renal artery greater than 50%, or any of the arteries leading up to it (proximal to the transplant renal artery) should be treated [ 10 , 11 ]. Percutaneous intervention procedure is the preferred initial mode of therapy [ 12 , 13 ]. The intervention procedure includes percutaneous transluminal angioplasty (PTA) and stent implantation.…”

Section: Discussionmentioning

confidence: 99%

Transplant renal artery stenosis caused by the stretch of an artey branch: a case report and literature review

Zhang

Meng

et al. 2018

BMC Nephrol

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BackgroundRenal transplant is the preferred treatment option for these patients with end-stage renal disease. Transplant renal artery stenosis (TRAS) is one of the most common and serious vascular complications after renal transplantation, and most of the TRAS occurred in the anastomosis. The complication must be diagnosed and treated timely, otherwise the function of transplanted kidney may be losed.Case presentationA 46-year-old male with end-stage renal disease of unknown cause received a cadaveric renal transplant one year ago. Although three antihypertensive medications were administrated, his blood pressure gradually increased to 190/120 mmHg 3 weeks posttransplantation. Also the level of creatinine increased to 194 μmol/L.Color Doppler ultrasonography indicated a decreased resistance index (RI) in intrarenal arteries and increased blood flow of the transplant renal artery, therefore, a vascular complication of TRAS was suspected. Arteriography was performed and demonstrated TRAS caused by stretch of an artery branch, and the TRAS occurred in the distal site of the anastomosis instead of the anastomosis. Percutaneous transluminal bare stent implantation treatment was successfully performed. Satisfactory clinical efficacy with improvement in transplant renal function and renovascular hypertension was achieved after the interventional treatment.ConclusionTo our knowledge this is the first reported case of TRAS caused by stretch of an artery branch. When refractory hypertension and allograft dysfunction are presented posttransplantation, TRAS should be suspected. Color Doppler ultrasonography as a non-invasive examination may provide some valuable information, three-dimention CT can be useful for further diagnosis, but is seldom necessary. Arteriography provides the definitive diagnosis of TRAS. Percutaneous transluminal stent implantation treatment of TRAS has high success rate with minimal invasion and complications. When an artery branch situated on the stenosis, a bare stent rather than covered stent is the preferred choice.

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Section: Discussionmentioning

confidence: 99%

Transplant renal artery stenosis caused by the stretch of an artey branch: a case report and literature review

Zhang

Meng

et al. 2018

BMC Nephrol

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“…However, this is an invasive procedure, and the use of iodinated contrast poses the risk of nephrotoxicity . Doppler ultrasound is a safer , non‐invasive diagnostic modality that can be performed at the bedside and is used for screening . TRAS is diagnosed by demonstration of a focal flow abnormality characterized by elevated PSV, post‐stenotic turbulence, and decreased velocity distal to the site of turbulence .…”

Section: Discussionmentioning

confidence: 99%

Significance of elevated transplant renal artery velocities in the postoperative renal transplant patient

Siskind

Lombardi

Blum

et al. 2013

Clinical Transplantation

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“…4,5 We present a case of TRAS that was discovered during the evaluation for causes of a patient's failing transplanted kidney.…”

Section: Transplant Renal Artery Stenosis (Tras)mentioning

confidence: 99%

“…3 Percutaneous revascularization of TRAS is indicated to treat graft dysfunction; however, the conventional use of angiography to guide the intervention can put the graft at substantial risk of contrast nephropathy. 4,5 We present a case of TRAS that was discovered during the evaluation for causes of a patient's failing transplanted kidney.…”

Section: Restoration Of Renal Allograft Functionmentioning

confidence: 99%

Restoration of Renal Allograft Function via Reduced-Contrast Percutaneous Revascularization of Transplant Renal Artery Stenosis

Erwin¹,

Goel²,

Gebreselassie³

et al. 2015

Texas Heart Institute Journal

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Transplant renal artery stenosis (TRAS),R enal transplantation is the definitive therapy for end-stage kidney disease and provides substantial lifesaving and quality-of-life benefits for patients who would otherwise undergo dialysis.1 Posttransplantation stenosis of the renal artery-more commonly called TRAS, or transplant renal artery stenosis-is the most frequent vascular complication of kidney transplantation.2 It is implicated in graft dysfunction, concomitant congestive heart failure, and refractory hypertension. Transplant renal artery stenosis is often detected during routine Doppler-ultrasonographic screening of the transplanted kidney or during the clinical evaluation that occurs when graft function deteriorates.3 Percutaneous revascularization of TRAS is indicated to treat graft dysfunction; however, the conventional use of angiography to guide the intervention can put the graft at substantial risk of contrast nephropathy. 4,5 We present a case of TRAS that was discovered during the evaluation for causes of a patient's failing transplanted kidney. Case ReportIn January 2013, a 70-year-old man with end-stage polycystic kidney disease underwent cadaveric kidney transplantation. He had a history of hypertension, transient ischemic attack, and coronary artery disease. In the 4 months after his kidney transplantation, he had hospital admissions for heart failure, gastrointestinal bleeding, and acute coronary syndrome requiring percutaneous coronary intervention. The patient's serum creatinine levels increased steadily during this time, from 1.47 mg/ dL at the time of transplantation to 6.99 mg/dL 5 months after transplantation. The rise in creatinine was attributed to cumulative kidney damage from intra-arterial contrast medium administered during the above-mentioned percutaneous coronary intervention, to acute tubular necrosis from hypotension, and possibly to cardiorenal syndrome. Five months after the transplantation, he presented with refractory pulmonary edema and acute-on-chronic renal failure (serum creatinine level, 6.05 mg/ dL). He was treated with diuresis, which further elevated the creatinine to a peak of 7.31 mg/dL. Hemodialysis was initiated to treat azotemia and volume overload. Biopsy specimens of the transplanted kidney did not reveal any specific cause for his Case Reports

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Transluminal Angioplasty of Transplanted Renal Artery Stenosis: A Review of the Literature for Its Safety and Efficacy

Cited by 14 publications

References 19 publications

Transplant renal artery stenosis caused by the stretch of an artey branch: a case report and literature review

Transplant renal artery stenosis caused by the stretch of an artey branch: a case report and literature review

Significance of elevated transplant renal artery velocities in the postoperative renal transplant patient

Restoration of Renal Allograft Function via Reduced-Contrast Percutaneous Revascularization of Transplant Renal Artery Stenosis

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