Peripheral vascular disease and renal transplant artery stenosis: a reappraisal of transplant renovascular disease

Becker, Bryan N.; Odorico, Jon S.; Becker, Yolanda T.; Leverson, Glen; McDermott, John C.; Grist, T.M.; Sproat, Ian A.; Heisey, Dennis M.; Collins, Bradley H.; D’Alessandro, Anthony M.; Knechtle, Stuart J.; Pirsch, John D.; Sollinger, Hans W.

doi:10.1034/j.1399-0012.1999.130412.x

Cited by 70 publications

(45 citation statements)

References 21 publications

(21 reference statements)

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“…Small, subtle intimal flaps or subintimal dissections of the vascular wall precede intimal scarring and hyperplasia that result in narrowing or occlusion of the lumen (13). Stenoses occurring later, sometimes several years posttransplant, usually reflect atherosclerotic disease either of the transplant renal artery or of the adjacent proximal iliac artery (14).…”

Section: Pathogenesismentioning

confidence: 99%

Transplant Renal Artery Stenosis

Bruno

Remuzzi

Ruggenenti

2004

Journal of the American Society of Nephrology

290

141

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Abstract. Transplant renal artery stenosis (TRAS) is a recognized, potentially curable cause of posttransplant arterial hypertension, allograft dysfunction, and graft loss. It usually occurs 3 mo to 2 yr after transplantation, but early or later presentations are not uncommon. The prevalence ranges widely from 1 to 23% in different series, reflecting the heterogeneous criteria used to establish the diagnosis, the different manner of preservation of the graft, and surgical expertise. Reported cases are progressively increasing in parallel with the use of non-invasive investigation procedures, such as Doppler ultrasonography and magnetic resonance (MR) angiography,

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Section: Pathogenesismentioning

confidence: 99%

Transplant Renal Artery Stenosis

Bruno

Remuzzi

Ruggenenti

2004

Journal of the American Society of Nephrology

290

141

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“…7 TRAS typically arises at or close to the anastomotic site and is often related to vascular intimal hyperplasia or, if presenting years after transplant, progressive atherosclerosis. 8 In this patient, TRAS documented on CT and colour Doppler US was markedly improved after bilateral native nephrectomy, which suggests a reversible etiology. In contrast to transplant renal artery stenosis the typical presentation of TRAS from intimal hyperplasia or atherosclerosis, this patient may have developed TRAS from mechanical compression or kinking of the transplant renal artery.…”

Section: Discussionmentioning

confidence: 83%

Transplant renal artery stenosis secondary to mechanical compression from polycystic kidney disease: A case report

Lee

Gunaratnam

Şener

2013

CUAJ

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Transplant renal artery stenosis (TRAS) is a potentially treatable cause of allograft dysfunction, hypertension and graft loss. The mainstay of treatment includes angioplasty and endovascular stenting, although observation and surgery are at times indicated. We present an unusual case of TRAS secondary to mechanical compression from a patient's enlarged native polycystic kidneys. This was treated with bilateral native nephrectomy and evidence of TRAS improved both clinically and radiographically. Recognition and treatment are important in preventing irreversible complications of TRAS.

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“…7 O surgimento precoce da estenose é principalmente devido à injúria intimal traumática durante a retirada ou manipulação do vaso, acotovelamento da artéria quando esta é mais longa que a veia ou por problemas técnicos com a sutura vascular, enquanto artéria renal do enxerto ou evolução da aterosclerose da artéria renal e/ou ilíaca. 8 A média de tempo entre o transplante renal e a apresentação clínica encontrada por nós foi de 396,3 dias, sendo que 67,8% (19/28) dos pacientes desenvolveram sintomas de EART nos primeiros 6 meses após o transplante.…”

Section: Discussionunclassified

“…Algumas séries publicadas relatam bem como no número de medicações anti-hipertensivas, 19,8 estatística. 20 Em nosso estudo a maioria desses resultados não de creatinina pós-operatória parece ser mais consensual, com a maioria dos relatos mostrando uma redução importante após o tratamento, resultado também observado por nós.…”

Section: Discussionunclassified

Tratamento endovascular de estenose de artéria renal em rim transplantado

et al. 2017

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RESUMOIntrodução: a estenose de artéria renal transplantada (EART) é a complicação vascular mais frequente do transplante renal. O Objetivo: avaliar o sucesso clínico, a patência primária e secundária da ATP, bem como a sobrevida dos pacientes após o tratamento endovascular. Métodos: análise retrospectiva dos pacientes com EART tratados por ATP no período de janeiro de 2008 a dezembro de 2016 no Hospital Universitário Walter Cantídio. Resultados: 28 pacientes foram tratados por EART através do método endovascular. A pressão diastólica reduziu de 91,62 mmHg para 76 mmHg, em média, após 6 meses do tratamento (p<0,05). Observou-se uma redução nos níveis de creatinina após 3, 6 e 24 meses da angioplastia (p=0,005). As taxas de patência primária em 1, 3, 6, 12 e 24 meses foram de 89,3% +/-5,8%, 85,6% +/-6,7%, 81,8% +/-7,4%, 78,1% +/-7,9% e 68,9% +/-9,3%, respectivamente. A taxa de patência secundária foi de 100%. A taxa de sobrevida em 1, 3, 6, 12 e 24 meses foi de 96,4% +/-3,5%, 96,4% +/-3,5%, 92,6% +/-5,1%, 92,6% +/-5,1% e 83,8% +/-7,5%, respectivamente. Conclusão: o tratamento endovascular de EART apresenta boas taxas de patências primária e secundária e é efetivo em restaurar e manter a função renal em dois anos.Palavras-chave: Transplante de rim. Obstrução da artéria renal. Angioplastia. Sobrevida. ABSTRACTIntroduction: Transplant renal artery stenosis (TRAS) is the most frequent vascular complication of renal transplantation. The diagnosis is made through arteriography and the treatment consists of percutaneous transluminal angioplasty (PTA). Objective: to evaluate the clinical success, the primary and secondary patency of PTA, as well as the survival of patients after endovascular treatment. Methods: Retrospective analysis of patients with TRAS treated by PTA from January 2008 to December 2016 at Hospital Universitário Walter Cantídio. Results: 28 patients were treated by TRAS using the endovascular method. Diastolic pressure decreased from 91.62 mmHg to 76 mmHg, on average, after 6 months of treatment (p <0.05). There was a decrease in creatinine levels after 3, 6 and 24 months of angioplasty (p = 0.005). The primary patency rates at 1, 3, 6, 12 and 24 months were 89.3% +/-5.8%, 85.6% +/-6.7%, 81.8% +/-7 , 4%, 78.1% +/-7.9% and 68.9% +/-9.3%, respectively. The secondary patency rate was 100%. The survival rate at 1, 3, 6, 12 and 24 months was 96.4% +/-3.5%, 96.4% +/-3.5%, 92.6% +/-5, 1%, 92.6% +/-5.1% and 83.8% +/-7.5%, respectively. Conclusion: Endovascular treatment of TRAS presents good rates of primary and secondary patency and is effective in restoring and maintaining renal function in two years.

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Peripheral vascular disease and renal transplant artery stenosis: a reappraisal of transplant renovascular disease

Abstract: Renal transplant renovascular disease encompasses pre-existing PVD acting as pseudoRTAS, as well as classical RTAS. Efforts to identify and correct renal transplant renovascular disease of either nature are important, given its negative impact on graft survival.

Cited by 70 publications

References 21 publications

Transplant Renal Artery Stenosis

Transplant Renal Artery Stenosis

Transplant renal artery stenosis secondary to mechanical compression from polycystic kidney disease: A case report

Tratamento endovascular de estenose de artéria renal em rim transplantado

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