Tailoring the Endovascular Management of Transplant Renal Artery Stenosis

Abstract

In this study we analyze the different types of endovascular interventions (EVIs) in de novo transplant renal artery stenosis (TRAS) and its anatomical subtypes to examine any variation in recovery of allograft function, blood pressure control, EVI patency and allograft survival with respect to EVI type (DES: drug-eluting stent, BMS: bare-metal stent, PTA: percutaneous transluminal angioplasty). Forty-five patients underwent a total of 50 primary EVIs (DES: 18, BMS: 26, PTA: 6). Patients were stratified according to medical co-morbidities, graft characteristics, biopsy results, clinical presentation and TRAS anatomic subtypes (anastomotic: 26, postanastomotic: 17, bend-kink: 2). There was significant improvement in allograft function and mean arterial blood pressure (MAP) control across all interventions (pre-EVI-creatinine[CR]: 2.8 AE 1.4, post-EVI-Cr: 2.1 AE 0.7, p < 0.001; pre-EVI-MAP: 117 AE 16, post-EVI-MAP: 112 AE 17, p ¼ 0.03) with no significant difference among EVI types. There was no significant difference in allograft survival with respect to EVI type. Patency was significantly higher in EVIs performed with DES and BMS compared to PTA (p ¼ 0.001). In the postanastomotic TRAS subtype, patency rates were significantly higher in DES compared to BMS (p ¼ 0.012) in vessels of comparable reference diameter ( 5 mm).

5 Years Experience With Drug Eluting and Bare Metal Stents as Primary Intervention in Transplant Renal Artery Stenosis

“…12 The use of DES in that population was supported by the high rate of restenosis (40-50%) seen when bare metal stents (BMS) were used in small native renal vessels. 13,14 Recently, a similar approach of using DES, BMS and PTA based on clinical parameters was confirmed to have positive short term clinical outcomes. 15 Currently, we present our long-term clinical and procedural outcomes on 57 patients with clinically significant TRAS, using DES for vessel diameters of 5 mm or less and BMS for vessel diameters greater than 5 mm.…”

Successful Treatment of Resistant Hypertension Associated Ascıtes in a Renal Transplant Patient

“…However, they noted that no consensus existed for the appropriate intervention [3]. Biederman et al compared drug eluting stents and bare metal stents in endovascular balloon dilation on 45 patients, and indicated that long term outcomes of drug eluting stents were superior [7]. In our patient the stenotic segment was widened by 90%, and ascites and hypertension completely resolved.…”

“…However, the narrowing of more than 70% is generally symptomatic, and leads to refractory hypertension [7]. Our patient had resistant hypertension and asciImage 1.…”

“…Nonetheless, we did not detect any signs of pulmonary oedema in clinical or radiological examination of the patient. TRAS is a vascular complication following renal transplantation, current treatment of which includes approaches of endovascular-balloon-dilation and stent implantation [2,4,7]. Salsamendi et al reported good outcome with endovascular balloon dilation on three patients with TRAS [1].…”

“…Early diagnosis and treatment of TRAS is important for prevention of graft damage and the systemic effects of hypertension. As a consequence of the developments in interventional radiology, operations including endovascular-balloon-angioplasty and stent implantation are more commonly performed treatment modalities [4,5,6,7,8]. Herein, we report an interesting case with transplant renovascular hypertension and ascites, both problems of whom resolved with a successful intervention of renal angioplasty.…”