Autotransplantation for the treatment of severe renal artery stenosis in a solitary kidney after repeated percutaneous transluminal angioplasty: a case report

Quang, Michael Nguyen; Krüger, Bernd; Wenning, Martin; Krüger, Christopher D.; Tokmak, Faruk; Kisters, Klaus; Wünsch, Andreas; Schenker, Peter; Viebahn, Richard; Krämer, Bernhard K.

doi:10.5414/cn107073

Cited by 2 publications

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“…Open hepatosplenorenal bypass can contribute to long-term bypass patency; however, it is invasive and can cause liver and spleen injury or infarction [4]. In contrast, the usefulness and safety of kidney autotransplantation (AutoTx) as a treatment for renal artery stenosis after PTRA have only been rarely reported [5].…”

Section: Introductionmentioning

confidence: 99%

Kidney autotransplantation for the treatment of renal artery occlusion after endovascular aortic repair: a case report

et al. 2019

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Background Unintentional renal artery occlusion after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm remains one of the most unfavorable complications. Renal salvage options include percutaneous transluminal renal artery angioplasty (PTRA) and open hepatosplenorenal bypass. However, the usefulness of kidney autotransplantation (AutoTx) remains unclear. Case presentation A 76-year-old woman with a right solitary kidney attributable to a left renal thromboembolism had previously undergone EVAR with a stent graft for an infrarenal aortic aneurysm, which led to ostial occlusion of the right renal artery. In addition, she had undergone PTRA and stenting. Two days before admission, she developed leg edema and hypertension, leading her to visit the hospital. Her serum creatinine level was 2.4 (baseline, 1.0) mg/dL. Acute kidney injury due to renal artery in-stent restenosis was suspected; re-angioplasty was attempted on day 2 of hospitalization, but was unsuccessful. Her renal function did not improve and anuria persisted; thus, hemodialysis was initiated on the same day. The right kidney size (8.6 cm) was preserved relative to her body size, with only mild cortical atrophy. Doppler ultrasonography and mercaptoacetyltriglycine scintigraphy revealed minimal but significant perfusion of the right kidney. Therefore, we considered that kidney perfusion was sustained and renal function could be reversed. On day 25 of hospitalization, right kidney AutoTx to the right iliac fossa was performed to reestablish adequate renal perfusion and reverse the need for dialysis. Soon after the procedure, the patient started passing urine. Her renal function improved; her serum creatinine level decreased to 1.0 mg/dL on day 33 of hospitalization. Hemodialysis was discontinued after the surgery. Zero-hour kidney biopsy showed only mild tubular injury, with neither tubular necrosis nor glomerular abnormalities. Conclusions Kidney AutoTx can be performed for patients with renal artery in-stent occlusion after unsuccessful PTRA who previously underwent EVAR. Our case showed successful recovery of renal function nearly 1 month after renal artery occlusion, indicating that revascularization should be considered even if it is delayed, as the kidney might be perfused through collateral circulation.

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Section: Introductionmentioning

confidence: 99%

Kidney autotransplantation for the treatment of renal artery occlusion after endovascular aortic repair: a case report

et al. 2019

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“…Cardiovascular disease (CVD) is the leading cause of global death. 1 Currently, interventional procedures, including balloon angioplasty, percutaneous transluminal coronary angioplasty, and stent implantation, are some routinely employed therapeutic options, 2,3 although patients often develop restenosis following these procedures. 4,5 Migration of vascular smooth muscle cells (SMCs) to the intimal space of blood vessels is a major cause of restenosis.…”

Section: Introductionmentioning

confidence: 99%

Bilayered Nanoparticles with Sequential Release of VEGF Gene and Paclitaxel for Restenosis Inhibition in Atherosclerosis

Zhu¹,

Xie

Liang³

et al. 2017

ACS Appl. Mater. Interfaces

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Complete reendothelialization followed by inhibition of smooth muscle cell (SMC) proliferation is considered as an effective therapeutic option to prevent restenosis. We have designed poly(lactide-co-glycolide)-loaded bilayered nanoparticles (NPs) with the ability to sequentially release vascular endothelial growth factor (VEGF)-encoding plasmids from the outer layer and paclitaxel (PTX) from the core to promote endothelial regeneration as well as prevent restenosis. Comparing with conventional NPs, which release VEGF plasmid and PTX simultaneously, we expect that the bilayered NPs could release the VEGF plasmid more rapidly, followed by a delayed release of PTX, resulting in an efficient VEGF gene transfection, which ideally could promote reendothelialization and inhibit excessive SMC growth. Indeed, in the present study, we have observed efficient gene transfection using a model plasmid as well as cell growth attenuation in vitro using Chinese hamster ovary cells. Therapeutic efficacy of the bilayered NPs on restenosis was further evaluated in vivo using a rabbit model of atherosclerosis. The bilayered NPs were administered locally via balloon angioplasty to the injured aortic wall through perfusion. Twenty-eight days after the NP administration, rabbits treated with the bilayered NPs exhibited rapid reendothelialization and inhibition of restenosis, as demonstrated by histological analysis. Increased level of VEGF and decreased level of C-reactive protein, a biological marker that is closely related to atherosclerosis, were also observed from animals treated with the bilayered NPs, implicating ameliorated atherosclerosis. Our results suggest that the VEGF plasmid-/PTX-loaded bilayered NPs exert a beneficial impact on atherosclerotic restenosis by sequentially releasing VEGF and PTX in vivo.

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Autotransplantation for the treatment of severe renal artery stenosis in a solitary kidney after repeated percutaneous transluminal angioplasty: a case report

Cited by 2 publications

References 0 publications

Kidney autotransplantation for the treatment of renal artery occlusion after endovascular aortic repair: a case report

Kidney autotransplantation for the treatment of renal artery occlusion after endovascular aortic repair: a case report

Bilayered Nanoparticles with Sequential Release of VEGF Gene and Paclitaxel for Restenosis Inhibition in Atherosclerosis

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