Interventional therapy of vascular complications following renal transplantation (original) (raw)
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Renal transplant vascular complications: the role of Doppler ultrasound
Journal of Ultrasound, 2014
Improvements in the care of kidney transplant recipients and advances in immunosuppressive therapy have reduced the incidence of graft rejection. As a result, other types of kidney transplant complications, such as surgical, urologic, parenchymal, and vascular complications, have become more common. Although vascular complications account for only 5-10 % of all post-transplant complications, they are a frequent cause of graft loss. Ultrasonography, both in B-mode and with Doppler ultrasound, is a fundamental tool in the differential diagnosis of renal allograft dysfunction. Doppler ultrasound is highly specific in cases of transplanted renal artery stenosis, pseudoaneurysms, arteriovenous fistulas, and thrombosis with complete or partial artery or vein occlusion. A single measurements of color Doppler indexes display high diagnostic accuracy and in particular cases are more useful during the post-transplantation follow-up period. More recent techniques, such as contrast-enhanced ultrasound, undoubtedly increase the accuracy of ultrasonography in the diagnosis of vascular complications involving the transplanted kidney. Keywords Ultrasonography Á Doppler ultrasound Á Renal transplant Á Vascular complications Riassunto La progressiva riduzione dell'incidenza del rigetto ha reso più frequenti le complicanze urologiche, chirurgiche, parenchimali e vascolari. Queste ultime, pur rappresentando soltanto il 5-10 % di tutte le complicanze post-trapianto, sono frequente causa di perdita del graft. L'esame ultrasonografico, sia in B-mode che con l'ausilio del color Doppler, è fondamentale nella diagnosi differenziale delle cause che possono innescare una disfunzione del graft. Sebbene sia ormai indiscussa la sua utilità nella diagnosi di complicanze parenchimali, chirurgiche e urologiche, non è ancora consolidato il suo ruolo in caso di
Management of vascular and nonvascular complications after renal transplantation
Techniques in vascular and interventional radiology, 2009
Renal transplantation is the treatment of choice for end-stage renal disease. Despite medical and surgical advances, vascular and nonvascular complications remain common post transplantation, occurring in 12%-20% of patients (Kobayashi K, Censullo ML, Rossman LL, et al: Radiographics 27:1109-1130, 2007; Orons PD, Zajko AB: Radiol Clin North Am 33:461-471, 1995). Complications of renal transplantation can range from minor complications, such as peri-graft fluid collections, to severe complications, such as renal vein thrombosis or transplant renal artery stenosis (TRAS). These complications may compromise graft function and cause significant morbidity. Most postoperative complications can be diagnosed by radiologic evaluation and often times can be treated by minimally-invasive, interventional radiologic procedures. A thorough understanding of how the complications impair allograft function and survival is essential in allowing adequate treatment. Interventional radiology plays an in...
Transplantation, 1996
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,
Clinical Imaging, 2009
Objective: The aim of this study was to investigate differences in Doppler parameters between severe transplant renal artery stenosis (TRAS, arterial lumen reduction N80%) with end-to-end (EE) arterial anastomosis and that with end-to-side (ES) arterial anastomosis. Methods: We retrospectively reviewed color duplex sonography (CDUS) and digital subtraction angiography (DSA) images in 38 patients with severe TRAS (19 cases with EE and 19 cases with ES) between January 1, 2000, and December 31, 2006. Doppler parameters were analyzed, including peak systolic velocity (PSV) in the iliac artery, PSV at the arterial anastomosis, PSV in the transplant renal artery, PSV ratio of the stenotic artery/artery proximal to the stenosis, and acceleration time (AT) in the artery distal to the stenosis (in the intrarenal artery). All 38 cases with severe TRAS were initially diagnosed with CDUS and confirmed by DSA. Results: There were significant differences in PSV in the stenotic artery (Pb.01), PSV in the iliac artery (Pb.001), and PSV ratios of stenotic artery/artery proximal to the stenosis (Pb.001) between arterial anastomosis of EE and that of ES. There was no statistically significant difference in AT in the intrarenal artery between the two types of anastomosis (PN.05). Conclusion: Significantly different PSVs in the stenotic artery, the iliac artery, and the PSV ratio between EE and ES arterial anastomoses should be considered in the interpretation of CDUS when screening for severe TRAS. Different criteria of CDUS need to be established depending on the type of arterial anastomosis in order to improve the accuracy in diagnosing severe TRAS.
Journal of Clinical Ultrasound, 2005
C adaveric or living donor renal transplantation is commonly performed in individuals with end-stage renal disease. In recent years, gray-scale sonography, coupled with color Doppler sonography (CDUS), power Doppler sonography (PDUS), or spectral Doppler sonography, has become the primary imaging modality for these patients. Postoperative serial sonography is performed to detect complications and aid in posttransplant management. In addition, sonography is used to guide percutaneous aspiration of fluid or biopsy to diagnose rejection or renal and perirenal masses. In this article we discuss the spectrum of sonographic findings, both vascular and nonvascular, of renal transplant complications, including but not limited to renal arterial and venous stenosis and thrombosis, peritransplant collections (lymphoceles, hematomas, urinomas, and seromas), posttransplant lymphoproliferative disorder, and postbiopsy complications (hematomas, pseudoaneurysms, and arteriovenous fistulas). We correlate sonographic findings with those from other imaging modalities (such as angiography, CT, and MRI) and findings at surgery and pathology when possible.
Vascular complications after 725 kidney transplantations during 3 decades
Transplantation Proceedings, 2003
Among 725 renal transplantations, the most common vascular complication was arterial stenosis, which was observed in 23 patients (3.17%). The majority of 20 (6.49%) arterial stenoses appeared in our initial experiences when we routinely used end-to-end renal graft to internal iliac artery anastomoses. A significant reduction in this incidence (0.72%) was achieved by introducing end-to-side anastomoses of the renal graft artery to the external or common iliac arteries. Intractable hypertension or impaired renal function in 14 patients (60.87%) with arterial stenosis demanded treatment. Patch angioplasty was more successful than other methods. The limited possibilities of conservative treatment of arterial hypertension at that time were the main reason for this frequent surgical repair. Among other vascular complications, the most serious were 12 episodes of arterial bleeding in 10 patients. Five kidneys were lost because of ruptured arterial anastomoses. In 6 patients, the common or external iliac artery was ligated as to achieve hemostasis with acute arterial insufficiency of the lower extremity in 4 patients. One patient required leg amputation, whereas 2 underwent extra-anatomic bypass procedures and 1 died because of hepatic failure. The majority of vascular complications occurred in the initial period of our transplantation practice. However, in spite of progress in diagnostic and treatment options, vascular complications may cause considerable clinical problems.
Nephrology Dialysis Transplantation, 2011
Transplant renal artery stenosis (TRAS) is a recognized complication resulting in post-transplant hypertension associated with allograft dysfunction. It is a commonly missed but potentially treatable complication that may present from months to years after transplant surgery. In this retrospective study, we compared management strategies and outcomes of TRAS from 1990 to 2005. Case notes of transplant recipients with TRAS demonstrated by angiography were reviewed. Angiography and was carried out when there was a clinical or Doppler ultrasound suspicion of TRAS. The clinical diagnosis of TRAS was based on uncontrolled refractory/new-onset hypertension and/or unexplained graft dysfunction in the absence of another diagnosis, such as rejection, obstruction or infection. The two-tailed Student t-test was used to analyse the differences between mean arterial pressure, serum creatinine, and estimated glomerular filtration rate before and after the intervention. Sixty-seven patients with angiogram-confirmed TRAS were included. Forty-four, 9 and 14 patients were managed with primary percutaneous transluminal renal angioplasty (PTRA), surgical intervention and conservative treatment, respectively. Uncontrolled hypertension was the most common presentation noted in 74.62%. Post-anastamotic single stenosis was the commonest occurrence (n = 53). Angioplasty had the highest 1- and 5-year graft survival rate of 91% and 86%, respectively. The worst prognosis was noted in patients treated with secondary PTRA after failed surgery or secondary surgery after failed primary PTRA. TRAS is a recognized complication resulting in loss of renal allografts. Early Doppler ultrasound is a good primary diagnostic tool. Early intervention is associated with a good long-term graft function.