CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S7
DOI: 10.1055/s-0041-1730665
Abstract

Endovascular Management of Transplant Kidney Vascular Complications: Experience from a Single Institution

Surya Nandan Prasad
SRMS Institute of Medical Sciences, Bareilly, India
,
Surya Nandan Prasad
SRMS Institute of Medical Sciences, Bareilly, India
,
Vivek Singh
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
,
Rajendra Vishnu Phadke
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
› Author Affiliations

Background: Vascular complications, especially transplant renal artery stenosis, are among the most common causes of graft dysfunction. Other vascular complications are renal vessel thrombosis, pseudoaneurysm, postbiopsy active renal bleed, and intraparenchymal arteriovenous fistula formation. Endovascular interventions are the first-line treatment in these cases with excellent immediate and long-term results. Methods: A retrospective analysis of postrenal transplant patients (from 2010 to 2013) was done who were referred to our department for evaluation and endovascular management of vascular complications. They were evaluated first with Doppler and then with magnetic resonance angiography, if needed. Finally, conventional angiography was done with intent to confirm the diagnosis and treat the patients with angioplasty, stenting, or embolization in the same sitting, if required. Follow-up was done with serial blood pressure measurements, serum creatinine estimation, and Doppler, first in immediate postprocedure period, then at 3- and 6-month intervals. Results: A total of 10 patients were included in the study with a mean age of 40.6 years. Five of them had transplant renal artery stenosis, one intraparenchymal pseudoaneurysm, one upper polar arteriovenous fistula, one atherosclerotic right common iliac artery stenosis, and two presented with active contrast extravasations from upper pole arteries. Patients with renal artery stenosis were treated with stenting across the stenosis. Intrarenal pseudoaneurysm, arteriovenous fistula, and active contrast extravasations were treated with coil and/or glue embolization. Postprocedure follow-up showed immediate and long-term improvement in blood pressure control, decreased serum creatinine level, and cessation of hematuria. Conclusion: Vascular complications in renal transplant patients are an important cause of graft dysfunction and perioperative morbidity. They can be treated effectively with endovascular interventions with excellent immediate and long-term results.



Publication History

Article published online:
11 May 2021

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