PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY AND WALL STENT PLACEMENT IN THE TREATMENT OF TRANSPLANTED RENAL ARTERY STENOSIS.
Keywords:
Transplanted renal artery stenosis, kidney transplantation, renal angioplasty, balloon, stentAbstract
PURPOSE: We report our experience with percutaneous transluminal angioplasty (PTA) and endoluminal stent placement in the treatment of transplanted renal artery stenosis (TRAS).
MATERIALS AND METHODS: From February 1998 to February 1999, we performed PTA in 3 patients who were affected by TRAS and besides; | Wall stent was successfully implanted in | patient affected by transplanted renal artery stenosis. All transplanted kidneys were procured from cadaver donors. The patients were routinely evaluated with color Doppler ultrasonography (CDUS), and when there was the patient in whom the CDUS showed evidence of transplanted renal artery stenosis, the magnetic resonance imaging/angiography (MRI/MRA) and renal angiography would be performed. The mean interval between transplantation and stenosis detection was 9 months (range 4 to 12 months). When serious renal stenosis was diagnosed (stenosis greater than 50%). selected transplanted renal angiography, and endoluminal renal angioplasty had been performed in 3 patients. In 1 patient, an endoluminal metallic Wall stent was placed in the site of stenosis at the anastomotic site.
RESULTS: Clinical outcome was improved in all 3 patients (100 %), the patients became normotensive and there was large amount of urine flow after PTA. The mean residual renal stenosis after PTA was less than 25%. There was no major complication, only in 1 patient there was minor complication, that was a small false aneurysm occurred at the contralateral femoral artery punctured site, which was treated with US probe compression technique.
CONCLUSION: Percutaneous transluminal angioplasty and stent implantation is the initial interventive treatment of choice for high grade transplanted renal artery stenosis, with good clinical outcome. and low complication rate.
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Newman-Sanders, A. P., Gedroye, W. G., al-Kutoubi, M. A., Koo, C. and Taube, D.: The use of expandable metal stents in transplant renal artery stenosis. Clin. Rad., 50:245, 1995.
Schacht R.A. Martin, D.G., Karalukulasingam, R., Wheeler. C.S. and Lansing. A. M. Renal artery stenosis after renal transplantation. Amer. J. Surg., 131: 653, 1976.
Palmaz, J. C., Windeler, S. A., Garcia, F., Tio, F. O., Sibbitt, R. R. and Reuter, S. R.: Atherosclerotic rabbit aortas : expandable intraluminal grafting. Radiology, 160:723, 1986.
Kauffman, H.M., Sampson, D., Fox, P.S., Doyle, T. J. and Maddison, F.E. : Prevention of transplant renal artery stenosis. Surgery, 81:161, 1977.
Tilney, N.L., Rocha, A., Strom, T.B. and Kirkman, R. L. : Renal artery stenosis in transplant patients. Ann. Surg., 199:454, 1984.
Macia, M., Paez., A., Tornero, F., De Oleo, P., Hidalgo, L. and Barrientos, A. : Posttransplant renal artery stenosis : a possible immunological phenomenon. J. Urol., 145: 215,1991.
Chan, H. W., Ho, Y., Chan, C., Yiu, T., Tong, M. K. and Wong, P. H. : Treatment of anastomotic ostial allograft and renal artery stenosis with the Palmaz stent. Transplantation, 59 : 436, 1995.
Erley, C.M., Duda, S. H., Wakat, J.P., Sokler, M., Reuland, P., MullerSchauenburg, W., Lauchart, W. and Risler, T. : Noninvasive procedures for diagnosis of renovascular hypertension in renal transplant recipients-a prospective analysis. Transplantation, 54:863,1995.
Merkus, J. W.. Hoitsma, A. J., van Asten, W.N., Zeebregts, C. J., van der Vliet, J. A., Stryk, S.P.. Koene, R. A. and Skotnicki, S. H. : Echo-doppler diagnosis of renal allograft artery stenosis. Clin. Transplant, 9:383,1995.
Lacombe, M. : Arterial stenosis complicating renal allotransplantation in man : a study of 38 cases. Ann. Surg., 181:283, 1975.
Sankari, B. R., Geisinger, M., Zelch, M.., Brouhard, B., Cunningham, R. and Novick, A. C. : Post-transplant renal artery stenosis : impact of therapy on longterm kidney function and blood pressure control. J. Urol., 149:980,1996.
Benoit, G.. Moukarzel, M., Hiesse, C., Verdelli, G., Charpentier, B. and Fries, D.: Transplant renal artery stenosis : experience and comparative results between surgery and angioplasty. Transplant. Int., 3:137,1990.
Raynaud, A., Bedrossian, J.. Remy, J., Brisset,J. M.. Angel, C. Y. and Gaux, J. C. : Percutaneous transluminal angioplasty of renal transplant arterial stenosis. AJR, 146:853,1986.
Nicita, G., Marzocco, M., Villari, D., Li Marzi, V., Trippitelli, A., Doggweiler, R.. Santoro, G. and Grechi, G. : Percutaneous transluminal angioplasty (PTA) in the treatment of transplant renal artery stenosis (TRAS).J. Urol., Part 2, 155 : 686A, abstract 1499, 1996.
Grossman, R. A., Dafoe, D. C., Schoenfeld, R. B., Ring, E. j., McLean, G. K.., Oleaga,J. A., Freiman, D. B., Naji, A., Perloff, L. J. and Barker, C. F.: Percutaneous transluminal angioplasty treatment of renal artery stenosis. Transplantation, 34:339,1983.
Sigwart, U.. Kaufmann, U., Mirkovitch, V., Joffre, F. and Kappemberger, L. : Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. New Engl. J. Med., 316:701,1987.
Kuhn, F. P., Kutkhun, B., Kock, M., Torsello, G. and Modder, U. : Experience with the strecker stent in the treatment of renal artery stenosis after failed angioplasty or thrombenarterectomy (abstract). Radiology. 177:202.1990.
Rees,.C. R., Palniaz, J.'C.,. Becker, G:J., Ehrman, K. O., Richter, G. M., Noeldge. G., Katzen, B. T., Dake, M. D. and Schwarten, D. E. : Palmaz stent in atherosclerotic stenoses involving the ostia of the renal arteries : preliminary report of a multicenter study. Radiology, 181:507, 1991.
Wilms, G.E., Peene, P. T., Baert, A. L.. Nevelsteen, A. A. Suy, R. M., Verhaeghe, R. H., Vermylen, J. G. and Fagard, R. H. : Renal artery stent placement with use of the wallstent endoprosthesis. Radiology. 179:457,1991.
Roberts. J.P., Asher, N, L., and Fryd. D.S. ‘Transplant renal artery stenosis. Transplantation . 48:590,1989.
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