Artery Stenosis of the Renal Graft: Experience of a Center of Northeastern Brazil

Nasserala, Jarinne Camilo Landim; Oliveira, Cláudia Maria Costa de; Cerqueira, João Batista Gadelha de; Souza, Sabrina da Silva de; Silva, S.L.; Santos, Larissa Costa de Oliveira; Andrade, S Albuquerque; Barroso, Wilson Mendes; Fernandes, Paulo Roberto Nunes; Fernandes, Ailson Gurgel; Daher, Elizabeth De Francesco

doi:10.1016/j.transproceed.2015.11.004

Cited by 12 publications

(9 citation statements)

References 28 publications

(37 reference statements)

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“…The prevalence of TRAS observed in our study was 5.6%, similar to that found in other studies 3 , 5 , 6 , 11 . Our analysis revealed renal dysfunction, associated with abnormalities in Doppler ultrasonography, to be a major clinical presentation and to be present in 90% of cases, a finding similar to that in other reviews 4 , 5 .…”

Section: Discussionsupporting

confidence: 92%

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

Valle¹,

Cavalcante²,

Motta-Leal-Filho³

et al. 2017

Clinics

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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.

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Section: Discussionsupporting

confidence: 92%

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

Valle¹,

Cavalcante²,

Motta-Leal-Filho³

et al. 2017

Clinics

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“…Stenosis frequency varies within 5-23 % [1,3,[12][13][14]17]. Probability of arterial stenosis increases in the process of transplantation of multiarterial kidney allograft.…”

Section: Resultsmentioning

confidence: 99%

“…Probability of arterial stenosis increases in the process of transplantation of multiarterial kidney allograft. Poor surgical technique can also result in narrowing of the kidney artery: the damage of intima donor's vessels or recipient by the vascular clamps, the damage of intima donor's artery by the cannula during the process of perfusion; errors associated with the suture technique: purse-string effect of anastomosis narrowing, changing of blood flow by the stitch line, inappropriate stitching material, fiber-inflammatory reaction on the polypropylene; renal artery's inflection as a result of its insufficient or excessive length; renal artery's torsion; anastomosis «end-to-end» among the vessels, inappropriate diameter [1,3,[12][13][14]17]. During ultrasonic examination of kidney allograft the following features of arterial stenosis are determined: pulse wave like "tardus-parvus", peak systolic velocity (PSV) of blood flow in the renal artery >250 cm/s, formation between stenotic and prestenotic segments of velocity gradient >2:1, decreasing the index of resistance (IR) <0.56 [15,18].…”

Section: Resultsmentioning

confidence: 99%

“…During ultrasonic examination of kidney allograft the following features of arterial stenosis are determined: pulse wave like "tardus-parvus", peak systolic velocity (PSV) of blood flow in the renal artery >250 cm/s, formation between stenotic and prestenotic segments of velocity gradient >2:1, decreasing the index of resistance (IR) <0.56 [15,18]. Hemodynamic significant stenosis of kidney allograft artery (>70 %, pressure gradient >15 mm of mercury column) more likely leads to the kidney allograft's function violation and has the tendency to the progress with the continuous risk of the transplant loss [1,[12][13][14][15][16][17]. At the same time stenosis can lead to the kidney allograft artery thrombosis [19].…”

Section: Resultsmentioning

confidence: 99%

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Arterial reconstructions of kidney allograft

Vildanov

Nykonenko

Русанов

et al. 2017

ZMJ

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The adequacy of blood supply in the allograft is one of the main factors of kidney transplant vitality and function and the effectiveness of transplantation itself.The aim of the study was to investigate the effectiveness and variants of arterial reconstructions of kidney allograft. Material and Methods.The results of kidney transplantation were analyzed among 66 patients. During the period from 2012 to 2016, all of them were done kidney transplantation in the department of transplantology. There were 37 (56.1 %) men, 29 women (43.9 %), the average age at the time of surgery was 33.2 ± 12.0 years. According to the aim of the study all the patients were divided into two groups: the first group included 12 (18.2 %) recipients, who received an arterial reconstruction. The age of the patients was 30.8 ± 6.5 years, there were 6 (50 %) men, other -women. Another group involved 54 (81.8 %) patients without arterial reconstruction. The average age of recipients was 33.7 ± 12.9 years, there were 31 (57.4 %) men, 23 women (42.6 %). We analyzed duplex examination of kidney allograft on the 7.6 ± 1.9 day after kidney transplantation. Results.According to the analysis of duplex examination the features of blood disorder in kidney allografts were not determined. The differences between groups were non-significant (p > 0.05). There were not identified any stenosis, thrombosis or bleeding in any cases of arterial reconstructions of kidney allograft; function of kidney allograft has preserved for the period of 2.2 ± 1.4 years. Conclusions.Adequate arterial reconstruction of kidney allograft is effective and safe method of kidney preparation for transplantation. Одним із принципових факторів життєздатності та функції пересадженої нирки, а отже й ефективності трансплантації, є адекватність кровотоку в аллотрансплантаті.Мета роботи -вивчити ефективність і варіанти артеріальних реконструкцій ниркового аллотрансплантату.Матеріали та методи. Проаналізовані результати трансплантації нирки 66 хворим. З 2012 по 2016 р. їм виконана пересадка нирки у відділенні трансплантації. Чоловіків було 37 (56,1 %), жінок -29 (43,9 %), середній вік пацієнтів -33,2 ± 12,0 року. Згідно з метою роботи пацієнтів поділили на групи: першу становили 12 (18,2 %) реципієнтів, яким виконане хірургічне втручання на артеріях трансплантату. Середній вік пацієнтів -30,8 ± 6,5 року, чоловіків було 6 (50 %), інші -жінки; друга група -54 (81,8 %) пацієнти, в яких не було необхідності в артеріальних реконструкціях аллонирки. Середній вік реципієнтів -33,7 ± 12,9 року, чоловіків було 31 (57,4 %), жінок -23 (42,6 %). Аналізували дуплексне сканування ниркового аллотрансплантату в середньому на 7,6 ± 1,9 доби після пересадки нирки.Результати. Під час дуплексного ультразвукового сканування ознак порушення кровотоку в ниркових аллотрансплантатах не виявили. Відмінності між групами статистично невірогідні (p > 0,05). У жодному випадку не зареєстровано стенозів, тромбозів або кровотеч; за період спостереження 2,2 ± 1,4 року функція аллонирок збережена.Висновки. Адекватна артер...

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“…Marini et al defined hemodynamically significant TRAS as > 75% narrowing of the lumen diameter [ 2 ]. On the other hand, Nasserala et al defined it as > 50% narrowing of the arterial lumen [ 4 ]. Although the gold standard for the diagnosis of TRAS remains renal arteriography, angiographic stenosis was reported to have a poor correlation with hemodynamic parameters [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of transplant renal artery stenosis based on hemodynamic assessment using a pressure wire: a case report

Kadoya

Zen

Matoba

2018

BMC Cardiovasc Disord

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BackgroundTransplant renal artery stenosis (TRAS) is a serious complication after renal transplantation, leading to hypertension, deterioration in renal function, and/or graft loss. The incidence of TRAS reportedly varies from 1 to 23%, depending on its definition or diagnostic tools. The hemodynamic definition or therapeutic indication of TRAS is unclear.Case presentationA 66-year-old man with a history of diabetes, chronic kidney disease, and angina presented with a 2-week history of dyspnea and leg edema. He had undergone living-donor kidney transplantation for end-stage renal disease secondary to diabetic nephropathy 7 years earlier. He developed acute deterioration in renal function after the administration of an angiotensin II receptor blocker and required emergency hospitalization owing to acute congestive heart failure with pulmonary edema. A vasodilator and loop diuretics were administered following his admission, and the patient’s symptoms resolved quickly. Further investigation, including magnetic resonance angiography and ultrasonography, revealed severe stenosis of the transplant renal artery. Renal arteriography and pressure gradient measurement using a 0.014-inch pressure wire were performed. The systolic pressure gradient was 40 mmHg, and the resting Pd/Pa ratio (ratio of mean distal to lesion and mean proximal pressures) was 0.90 without hyperemia. Hemodynamically significant stenosis was suspected. Intravascular ultrasonography revealed vessel shrinkage in the stenotic area, suggestive of the end-to-end anastomosis site. Pre-dilation using a 4-mm balloon, implantation of a 6-mm self-expandable stent, and post-dilatation using a 5-mm balloon were performed. Although the moderate stenosis persisted angiographically, the systolic pressure gradient dropped to 20 mmHg with the mean systolic pressure ratio increased to 0.95, which was considered an acceptable result. One month after the procedure, the patient’s renal function and blood pressure control had significantly improved.ConclusionsHemodynamic assessment using a pressure wire is useful in determining the appropriate therapeutic indication and endpoint of endovascular treatment of TRAS.

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Artery Stenosis of the Renal Graft: Experience of a Center of Northeastern Brazil

Abstract: Grafts with 2 or more arteries are associated with TRAS, as well as patients who use a higher number of anti-hypertensive drugs. TRAS repair was associated with improved blood pressure control and renal function.

Cited by 12 publications

References 28 publications

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

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

Arterial reconstructions of kidney allograft

Endovascular treatment of transplant renal artery stenosis based on hemodynamic assessment using a pressure wire: a case report

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