Iliac artery stenosis proximal to a kidney transplant: clinical findings,duplex-sonographic criteria,treatment, and outcome

BACKGROUND: Stenosis of the iliac segment proximal to the transplant renal artery (Prox-TRAS) is an uncommon cause of graft dysfunction and hypertension. We assessed the role of duplex sonography (DS) in regard to clinical and angiographic findings and followed the patients after percutaneous transluminal angioplasty (PTA), PTA stenting (PTAS), or surgery. METHODS: From January 1988 to August 2001, 97 of 1,064 kidney recipients underwent angiography for clinical or Doppler-sonographic suspicion of vascular problems. Kidney function, blood pressure, medication, and DS findings after renal transplantation (RTx) at the time of diagnosis of Prox-TRAS and after treatment were evaluated. RESULTS: Prox-TRAS was diagnosed in 16 patients (1.5%) (49.6+/-6.9 years). Four patients demonstrated early presentation of Prox-TRAS 1 to 7 days after RTx (group A), leading to acute renal failure but without hypertension. In all patients, DS revealed pulsus parvus et tardus, low pulsatility index (PI) (<1.0), and a pathologic flow profile in the iliac artery proximal and distal to the graft. After treatment (surgery in two patients, PTA in one patient, PTAS in one patient), all patients developed good renal function (creatinine 1.7+/-0.9 mg/dL). PI increased from 0.9+/-0.1 to 1.2+/-0.1 (P=0.04), and flow profile within the iliac artery distal to the graft normalized. Late presentation (3-209 months after RTx) of Prox-TRAS was observed in 12 patients (group B), causing an increase of creatinine in 11 patients (two patients receiving dialysis treatments), impairment of blood pressure (141+/-15 and 80.7+/-7 to 160+/-18 and 85+/-7 mm Hg, P=0.009), and an increase in antihypertensive drugs (2.1+/-1.1 and 4.3+/-1, P=0.003) in all patients. The PI was decreased when compared with values early after RTx (1.6+/-0.4 to 1.2+/-0.3, P=0.007), and flow profile in the iliac artery was pathologic. All patients except one were managed by surgery (n=6), PTA (n=1), or PTAS (n=4). Creatinine (2.7+/-1.4 to 1.8+/-0.4 mg/dL, P=0.02) and blood pressure (160+/-18/85+/-7 mm Hg to 138+/-7/82+/-9, P=0.018) improved. Antihypertensive drugs were reduced to 2.8+/-0.8 (P=0.01). PI increased from 1.2+/-0.3 to 1.9+/-0.5 (P=0.01). Flow profile within the iliac artery distal to the graft anastomosis normalized. Kidney function, blood pressure, and PI remained unchanged during follow-up (82+/-69.9 months) in both groups. CONCLUSIONS: Prox-TRAS is rare. Because clinical symptoms are similar to those of transplant renal artery stenosis, DS is a valuable tool for diagnosis and follow-up for this type of vascular lesion. Selective treatment with PTA, PTAS, or surgery improves kidney function and hypertension.     

Primary endoluminal stenting of transplant renal artery stenosis from cadaver and non-heart-beating donor kidneys

This study evaluated the efficacy of primary endovascular stenting in cases of transplant renal artery stenosis (TRAS) from cadaver and non-heart-beating donor kidneys. Patients with TRAS (n = 13) from a single-centre transplant population (n = 476) were treated by primary percutaneous angioplasty and endovascular stenting. The short-term efficacy of this intervention is demonstrated in terms of serum creatinine, glomerular filtration rate (GFR) biochemical, anti-hypertensive medications and mean arterial blood pressure control. Stenting for TRAS was performed in male (n = 10) and female (n = 3) recipients. The median age at transplantation was 55 yr (range 10-67 yr). Stenting occurred at a median duration of 410 d post-transplantation (range 84-5799 d). Mean serum creatinine (pre, 247 micromol/L; post, 214 micromol/L; p = 0.002), GFR (pre, 82.6 mL/min; post, 100.9 mL/min; p < 0.001), arterial blood pressure (pre, 104 mmHg; post, 97 mmHg; p = 0.036) and the number of anti-hypertensive medications required (pre, 3.4; post, 3.0; p = 0.002) showed significant improvement after post-endovascular therapy. There were no serious complications encountered. Primary endovascular stenting of TRAS produces a significant improvement in biochemical parameters of renal graft function and in blood pressure stability, with the benefit of low patient morbidity and single arterial puncture. Primary endoluminal stenting of TRAS is a safe and effective procedure for the treatment of TRAS.     

Transplant renal artery stenosis: experience and comparative results between surgery and angioplasty

Abstract. One hundred thirty-eight patients with transplant renal artery stenosis (TRAS) were identified among 1200 patients undergoing renal transplantation in our university hospital. Severe systemic hypertension was the main symptom leading to a diagnosis of TRAS. Only 88 TRAS patients were given interventional treatment consisting of percutaneous angioplasty (PTA; n = 49) or surgical repair (SR; n = 39). The immediate success rate was 92. 1% for SR and 69% for PTA. The long-term success rate was 81. 5% for SR and 40. 8% for PTA, with a follow-up period of 56. 722. 4 months (SR group) and 3228. 1 months (PTA group). PTA morbidity reached 28%, compared to 7. 6% in the SR group. In spite of these results, we still favor PTA as a first line interventional treatment when TRAS is recent, linear, and distal and primary SR in cases of kinking and proximal TRAS.     

Transplant renal artery stenosis: experience and comparative results between surgery and angioplasty

One hundred thirty-eight patients with transplant renal artery stenosis (TRAS) were identified among 1200 patients undergoing renal transplantation in our university hospital. Severe systemic hypertension was the main symptom leading to a diagnosis of TRAS. Only 88 TRAS patients were given interventional treatment consisting of percutaneous angioplasty (PTA; n=49) or surgical repair (SR; n=39). The immediate success rate was 92.1% for SR and 69% for PTA. The long-term success rate was 81.5% for SR and 40.8% for PTA, with a follow-up period of 56.7±22.4 months (SR group) and 32±28.1 months (PTA group). PTA morbidity reached 28%, compared to 7.6% in the SR group. In spite of these results, we still favor PTA as a first line interventional treatment when TRAS is recent, linear, and distal and primary SR in cases of kinking and proximal TRAS.     

Risk Factors and Long-Term Outcome of Transplant Renal Artery Stenosis in Adult Recipients After Treatment by Percutaneous Transluminal Angioplasty

Transplant renal artery stenosis (TRAS) is a common complication of kidney transplantation but attempts to identify predisposing risk factors for TRAS have yielded conflicting results. In order to determine the predisposing factors for transplant (TRAS), we retrospectively reviewed the records of 29 renal allograft recipients with TRAS treated with percutaneous transluminal angioplasty (PTA). The TRAS group was compared with a case-control group of 58 patients. Predisposing factors for TRAS included CMV infection (41.4% vs. 12.1% p = 0.0018) and initial delayed graft function (DGF) (48.3% vs. 15.5% p = 0.0018), respectively in the TRAS and the control group. Acute rejection occurred more frequently in patients from the TRAS group (48.3%) compared with the control group (27.6%), although the difference was not significant (p = 0.06). In a multivariate analysis, only CMV infection (p = 0.005) and DGF (p = 0.009) appear to be significantly and independently associated with TRAS. The long-term graft survival was significantly higher in the control group, compared with the TRAS group (p = 0.03). Our study suggests that CMV infection and DGF are two reliable risk factors for TRAS. Despite treatment by PTA with primary successful results, TRAS significantly affects long-term graft outcome.     

Tratamiento endovascular de la estenosis de la arteria renal en el riñón trasplantado

IntroductionThe incidence of renal artery stenosis in the transplanted kidney (TRAS) varies between 2 and 23%, being the most frequent vascular complication following renal trasplantation. The delay in diagnosis and treatment can lead to functional graft loss. Percutaneous trasluminal angioplasty with stent (PTAS) is the treatment of choice to restore kidney perfusion.Materials and MethodsRetrospective review of renal transplant casuistic in our institution between September 2005 and August 2009. Were included patients with greater than 70% TRAS and impaired graft function, treated with PTAS. Follow-up at 3, 12 and 36 months was done with creatinine, glomerular filtration rate (GFR) and Doppler ultrasonography (DUS). Technical success was defined as correct stent placement associated with decreased flow, and clinical success as improve renal function during follow-up.ResultsIncidence of TRAS was 7.3% (22/298), 60% PTAS subsidiary. 100% technical success and 84.6% clinical success, 15.4% without changes in renal function. 84% decreases flow rate greater than 70% by DUS, and 26% up to 60%. Wave changes from type III to type II were recorded in 69% and to type I in 33%.ConclusionsThe PTAS is a safe and effective procedure for the treatment of selected TRAS patients, as it preserves vascular permeability in short and medium term, ensuring the functionality of the graft. DUS is the method of choice for diagnosis and monitoring TRAS.     

经皮腔内血管成形术联合支架置入治疗移植肾动脉狭窄的临床分析

目的  探讨经皮腔内血管成形术（PTA）联合支架置入治疗肾移植术后移植肾动脉狭窄（TRAS）的临床疗效。方法  回顾性分析21例肾移植术后TRAS行PTA联合支架置入治疗患者的临床资料。总结肾移植受者中TRAS的发生情况,比较TRAS患者介入治疗前后相关指标变化情况,分析TRAS患者的预后情况。结果  507例肾移植受者中有21例发生TRAS,发生率为4.1%（21/507）。TRAS诊断时间为术后5（4,7）个月,67%（14/21）在术后6个月内出现TRAS。与介入治疗前比较,介入治疗后1周和1个月TRAS患者血清肌酐、收缩压、舒张压以及移植肾动脉峰值血流流速均降低,估算肾小球滤过率（eGFR）、叶间动脉阻力指数均升高,差异均有统计学意义（均为P < 0.05）。PTA联合支架置入术后随访期间,共有1例出现移植肾动脉再发狭窄,经单纯球囊扩张后好转,1例右股动脉穿刺点假性动脉瘤形成,1例移植肾动脉闭锁导致肾脏萎缩失功,其余18例术后均恢复良好。结论  PTA联合支架置入是肾移植术后TRAS首选治疗方式,可明显改善移植肾功能,显著延长移植肾的生存时间。     

Long‐term outcomes of transplant recipients referred for angiography for suspected transplant renal artery stenosis

Our aim was to study the long‐term outcomes of all transplant recipients who underwent angiography for suspected TRAS at our institution. The patients were divided into TRAS+ve and TRAS?ve groups based upon angiographically confirmed results. TRAS was confirmed in 58.1% of 74 patients with median time of 8.9 months. Primary angioplasty alone was performed in 56% of patients with TRAS, while the remaining had PTA with stent (PTAS). There was reduction in systolic and diastolic BP (165 ± 19–136 ± 15 mmHg and 82 ± 14 mmHg to 68 ± 12 mmHg; p < 0.05) and number of antihypertensive drugs (3.5 ± 0.9–2.7 ± 1.0; p < 0.05). Overall, graft survival and patient survival from time of transplant were similar in both groups. Graft function was similar for the patients with treated TRAS+ve as compared to TRAS?ve over time. Graft survival and patient survival when compared to an age‐ and year of transplant‐matched cohort control group were also similar. In conclusion, angiography for suspected TRAS is more likely to yield a confirmatory result early in the transplant course as compared to late. Treatment of TRAS in these patients had sustained long‐term graft function. Alternative etiologies of HTN and graft dysfunction should be sought for recipients further out from transplant.     

Efficacy and safety of Palmaz stent implantation in the treatment of renal artery stenosis in renal transplantation

To verify the long-term efficacy and safety of Palmaz stent implantation in the treatment of transplant renal artery stenosis (TRAS), we reviewed the charts of 26 patients affected by TRAS and treated by percutaneous transluminal angioplasty (PTA) followed by permanent insertion of a Palmaz stent. The mean follow-up period was 43.31 +/- 33.6 months. The mean blood pressure fell significantly at 1 month after stenting (118 +/- 8.1 vs 101 +/- 7.8 mmHg; P < .0001); then remained stable. Renal artery blood flow, as determined by Doppler ultrasonography, was reduced from 352.5 +/- 56.5 to 157.3 +/- 53.7 cm/sec at 1 month after stenting (P < .0001). Renal function improved after stenting (serum creatinine 2.2 +/- 1.4 mg/dL preinsertion versus 1.72 +/- 1.05 at 3 years). In conclusion, in cases of severe or recurrent TRAS, stenting of the renal artery has proved to be an effective therapeutic tool. This method, which has low procedure costs and an extremely low complication rate has proved to be safe and to offer the potential of preserving luminal patency, improving the long-term efficacy of percutaneous angioplasty.     

Renal allograft artery stenosis: results of medical treatment and intervention. A retrospective analysis

In a retrospective analysis of 1165 renal transplantations in our center, 65 cases of renal allograft artery stenosis were diagnosed angiographically (prevalence 5.5%). Hypertension was present in all case; a bruit over the allograft and an increase in serum creatinine level were additional reasons for angiography. Shortly after diagnosis of the stenosis, two patients died and two others lost their grafts due to thrombosis. In 24 patients the decision was made not to correct the stenosis. One of these grafts was lost because the stenosis could not be corrected. Medical management of hypertension in these patients resulted in a decrease in diastolic blood pressure from 109±22 to 96±12 mm Hg (P<0.01) 3 months after diagnosis with the use of almost twice as many antihypertensive drugs as at the time of diagnosis (P<0.01). The stenosis was corrected if the angiography showed it to be so severe that it jeopardized renal allograft function or caused uncontrollable hypertension. Only three of nine percutaneous transluminal angioplasty (PTA) procedures resulted in a definitive correction of the stenosis. Surgical intervention was performed in 30 patients, including two patients whose PTAs had proved unsuccessful. Surgery led to graft loss due to thrombosis in 6 of 30 operations (20%), whereas restenosis occurred twice (7%). In three other case (10%), the correction was not successful due to local anatomical variations or concomitant rejection. Successful correction of the stenosis by either PTA or surgical intervention (n=22) resulted in a significant decrease in systolic (171±31 vs 145±27 mm Hg; P<0.01) and diastolic (103±15 vs 89±14 mm Hg; P<0.05) blood pressures 3 months after correction. Concomitantly, a decrease in the number of antihypertensive drugs from 2.1±1.0 to 1.5±1.0 (P<0.01) was achieved. In conclusion, renal allograft artery stenosis could successfully be managed pharmacologically, provided that allograft perfusion was not jeopardized. Successful surgical correction of a stenosis with effective control of hypertension was achieved in 63% of the cases. PTA was less frequently successful but did not cause any graft loss.     

移植肾动脉血流峰值速度加快与移植肾动脉狭窄相关性研究

目的:探讨肾移植术后半年内移植肾动脉血流峰值速度加快与移植肾动脉狭窄相关性。方法:回顾性分析我院102例肾移植患者术后半年内移植肾多普勒超声图像检查结果及临床资料,比较患者收缩期血流峰值速度(PSV)、血压及移植肾功能。结果:102例患者中,有27例患者出现较高的PSV,其中4例患者呈现持续性PSV升高,经行移植肾动脉造影检查而确诊为移植肾动脉狭窄(TRAS),行经皮肾动脉支架植入术(PTRAS)后,PSV降至正常,血压恢复正常,随访6~13个月未见狭窄复发。结论:在肾移植术后半年内,移植肾动脉PSV加快未必是肾动脉狭窄,可先随访观察,若超声提示PSV呈持续性升高,尤其是伴顽固性高血压,则需行移植肾动脉造影明确是否是TRAS。PTRAS是TRAS安全有效的治疗方法。     

Incidence and outcome of transplant renal artery stenosis: single center experience

Since the incidence of transplant renal artery stenosis (TRAS) in renal allografts varies from 1% to 23%, we sought to examine its incidence, to analyze treatment options, and to ascertain its outcomes. Retrospective analysis of 793 kidney allograft recipients transplanted between 1996 and 2004 revealed an incidence of 0.9% (n = 7). Time from kidney transplantation to the first symptoms varied from 1 week to 3 years (median, 4 months). Three patients experiences refractory hypertension and six patients developed allograft dysfunction. Screening color Doppler ultrasonography showed hemodynamic changes in six patients with the definitive diagnosis confirmed by angiography in all patients. One patient with an anastomotic stenosis was treated with a surgical operation and six patients, percutaneous transluminal angioplasty (PTA), with stenting in three cases. Both surgical as well as PTA treatment were successful in all but one patient, who underwent PTA alone, developed chronic renal insufficiency necessitating hemodialysis and finally lost his allograft. In the other patients all symptoms resolved after treatment and the patients are doing well with functioning allografts. Although TRAS was an uncommon complication, if recognized promptly it could be treated by surgery or PTA with a high success rate.     

A correlation between direct and indirect Doppler ultrasonographic measures in transplant renal artery stenosis

Screening for transplant renal artery stenosis (TRAS) with Doppler ultrasonography (DUS) is increasingly used in the era of kidney transplantation. Direct Doppler study of the stenotic site is a time- consuming and difficult method that requires an angle of interrogation parallel to the vessel. The aim of this study was to assess the correlation between the direct-PSVs (peak systolic velocity at the stenotic site), PSVs/PSVi (PSVi, peak systolic velocity of the adjacent iliac artery)-and indirect-intrarenal arterial resistive index (RI), perfusion index (PI), acceleration time (AT)-DUS findings in the kidney transplant recipients with TRAS. We performed 26 DUS studies of both intrarenal and main renal arteries in 19 TRAS patients (who had PSVs > 150 cm/s, PSVs/PSVi > 2). The mean values of PSVs and PSVs/PSVi were 212 +/- 44.19 cm/s and 2.77 +/- 0.77, respectively. The mean intrarenal RI, PI, and AT were 0.48 +/- 0.065, 0.70 +/- 0.12, and 177.8 +/- 54.6 msec, respectively. A significant negative correlation was found between PSVs and intrarenal RI (Pearson correlation coefficient (r) = -0.4, two-tailed P = .043). No correlation was found between intrarenal PI or AT and the direct DUS findings (P > .05). With a cutoff level of 0.55 for intrarenal resistive index, the sensitivity of this parameter to detect proximal renal arterial stenosis was about 85%. Conclusively, PSVs and intrarenal RI were negatively correlated. Intrarenal resistive index can be used as an screening measure for detection of TRAS.     

Minimally invasive salvage therapy for transplanted renal allografts

Abstract

Purpose: To evaluate the effectiveness of interventional therapy for complications of transplanted renal allografts. Materials and methods: Between January 2009 and March 2014, 14 patients underwent interventional therapy for complications of renal allografts. Complications included transplant renal artery stenosis (TRAS), TRAS combined with pseudoaneurysms, transplant renal venous kinking and ureteral obstruction (UO). Serum creatinine (S.Cr) levels were evaluated before and after procedure. The characteristics and procedure outcomes of these patients with vascular and nonvascular complications were also analyzed. Results: All primary procedures were successfully performed, which included percutaneous transluminal angioplasty (PTA) for TRAS (n?=?4), stenting and coil embolization for TRAS combined with pseudoaneurysms (n?=?1), stenting for renal vein kinking (n?=?2), and percutaneous nephrostomy (PCN) for UO (n?=?7) and secondary antegrade stent placement in six UO patients after 1 week of PCN. No major procedure related complications occurred. S.Cr level subsequently improved from 6.0?±?3.6 to 2.6?±?2.1?mg/dL (p?<?0.001), as well as patients’ clinical features within 1 week after procedure. In our study, the onset time of vascular complications was earlier (<6 months) than nonvascular complications with significant difference (p?<?0.001). During follow-up, the patient with TRAS and pseudoaneurysms suffered acute rejection 1 month after treatment and received transplant renal artery embolization. One patient with TRAS showed restenosis 4 months after procedure, and was retreated successfully with stenting. Thirteen cases reserved their transplanted renal allografts. Conclusion: Interventional therapy could be prior considered for transplanted renal allograft complications as its effectiveness and minimal invasiveness in saving the transplanted renal grafts.     

Doppler ultrasonographic indices after renal transplantation as renal function predictors

OBJECTIVES: Doppler ultrasonography is mostly used for assessment of both graft and native kidney vascular status. In this study, correlation between Doppler sonographic indices and transplanted kidney function was evaluated. METHODS: In our retrospective study, we reviewed data on 273 renal transplanted (RTx) patients. The Doppler ultrasonographic evaluation included resistive index (RI), pulsatility index (PI) in interlobar arteries as well as stenosis (TRAS) or thrombosis of renal arteries and veins. Serum creatinine (Cr) and cyclosporine levels (CsA) were measured just prior to sonography. RESULTS: The mean age of 154 male and 119 female patients was 36.67 +/- 13.13 years. Both RI and PI showed significant linear correlations with serum Cr (P = .033 and P = .002, respectively). Also, direct linear correlations existed between patient age and RI and PI values (P = .004; r = +.174 and P = .003; r = +.183 respectively). The prevalence of TRAS was 11.35%. Among patients with TRAS or thrombosis the mean Cr level (2.08 +/- 1.7 mg/dL) was significantly higher than that among patients without TRAS or thrombosis (1.48 +/- 0.97 mg/dL; P = .004). Despite this finding, RI and PI were significantly lower among patients with TRAS or thrombosis than those with a patent renovascular tributary (0.59 +/- 0.15 vs 0.65 +/- 0.11; P = .029 vs 1.02 +/- 0.40 vs 1.18 +/- 0.46; P = .049). CONCLUSIONS: Both RI and PI were two valuable Doppler ultrasonographic markers to evaluate renal allograft function and related vascular complications.     

Stenting of transplant renal artery stenosis: outcome in a single center study

AIM: Transplant renal artery stenosis (TRAS) is the most frequent vascular complication following transplantation and is a potential curable cause of resistant hypertension, allograft dysfunction, and graft loss. Percutaneous angioplasty (PTA) is the treatment of choice, but the incidence of restenosis may be as high as 35%. Alternative treatment option combines the angioplastic procedure with the placement of a stent. The aim of this study was to evaluate retrospectively the clinical outcome of 30 patients with TRAS or post-PTA recurrent TRAS between 1991 and 2006 treated by endoluminal stenting. Primary outcomes of this study were survival rate, percentage of restenosis and lost of the graft. Secondary outcomes were: reduction of blood pressure, creatinine levels and number of antihypertensive medications. METHODS: From May 1991 to May 2006 a retrospective review of stent placement procedures for TRAS was performed. Reviewed parameters included: technical success, arterial blood pressure and number of antihypertension medications, serum creatinine level before and after intervention. Thirty-two interventions in 30 allografts were carried out. Allograft survival rate was estimated using the Kaplan-Meier METHODS: RESULTS: The technical success rate of stenting was 100% with a single major complication event (a puncture site pseudoaneurysm). Mean follow-up time was 7.1 years; of the 30 allograft that underwent stent placement, all were patent at the last follow-up, with five restenosis (15.6%) of which only one needed to be retreated endoluminally. A reduction of the mean serum creatinine levels and of the number of blood pressure medications was observed. There was no difference in the survival curve of the grafts without TRAS compared to those with stenting treated TRAS. CONCLUSION: The treatment of the TRAS with selective or primary stenting is safe with a long-term patency rate. The efficacy of the stenting in this retrospective study is suggested by a decrease in mean systolic and diastolic blood pressure, serum creatinine levels and number of blood pressure medications.     

经皮血管成形术治疗移植肾动脉狭窄的临床研究

目的 评估经皮血管成形术在治疗移植肾动脉狭窄(TRAS)导致的移植肾功能损害和(或)高血压中的效果.方法 回顾性分析1998年7月至2007年1月经皮肾动脉造影明确诊断为移植肾动脉狭窄的16例患者的临床资料.在16例患者被确诊前先行多普勒超声检查,有13例被发现TRAS,3例阴性,假阴性率为18.75%.对16例TRAS患者均采取经皮血管成形术治疗.术后对患者进行了3年的随访,分别在术后1周、6个月、1年、2年和3年时评估肾功能和高血压改善状况.以平均动脉压较术前下降至少15%定义为高血压改善;以血清肌酐降低至少20%定义为移植肾功能改善.结果 经皮血管成形术成功率100%,16例患者经治疗后均获临床治愈.术后1周、6个月、1年、2年和3年时,肾功能改善率分别为81.25%、68.75%、62.5%、56.25%和50%,高血压改善率分别为62.5%、75%、75%、56.25%和50%,所有患者服用降血压药物的种类和用量均减少.结论 经皮血管成形术对TRAS导致的肾功能损害和高血压有明显的改善作用,是安全和有效的治疗方法 .     

Reduction in renal function after renal arteriography and after renal artery angioplasty.

OBJECTIVE: To investigate the incidence and risk factors for renal function deterioration after renal angiography and angioplasty or stenting. METHODS: A retrospective study of 85 consecutive patients undergoing selective renal artery arteriography (n = 53) or renal artery angioplasty % (PTRA) stenting (n = 32) for renal artery stenosis. Multivariate logistic regression analysis was used to determine independent predictors of deterioration of renal function, defined as an increase of serum creatinine by at least one third within 24 h. RESULTS: Deterioration of renal function occurred in 13 patients (15%), [8/53 (15%) after angiography and 5/32 (16%) after PTRA/stenting]. Only pre-existing renal impairment (se-creatinine > or = 177 mumol/l) (Odds ratio: 40; 95% confidence interval 1.2-72, p = 0.02) and administered dosage of contrast agent (more than 225 ml) (OR 67; 95% CI 11.8-100, p = 0.02) were independently associated with renal function deterioration. CONCLUSION: Transient renal dysfunction after renal artery angiography or PTRA/stenting occurs in about 15% of patients, but persistent renal failure is uncommon. Pre-existing renal impairment and amount of contrast agent are independent risk factors. Endovascular treatment of renal artery stenosis is not associated with a higher risk of renal deterioration compared to selective renal angiography.     

移植肾动脉狭窄腔内治疗的中期结果

目的探讨移植肾动脉狭窄经皮血管腔内成形(PTA)及支架置入的安全性及中远期结果。方法回顾性分析2011年1月至2018年12月解放军总医院血管外科收治的18例移植肾动脉狭窄患者的临床资料。结果3例经同侧股动脉,15例经对侧股动脉人路治疗。4例单纯PTA治疗,8例PTA后置入支架,6例直接置入支架。共置入14枚支架,均为球扩式支架,其中2枚为药涂支架,技术成功率100%。平均造影剂用量64ml,治疗前肾动脉狭窄率为50%〜99%,腔内治疗后狭窄率降为10%〜30%。收缩压由术前的(157.2±43.0)mmHg降至术后的(129.8±8.6)mmHg;血清肌酐(SCr)水平由术前的(258.8±214.7)μmol/L降至术后的(176.3±101.1)μmol/L,尿素氮由术前的(15.7±1.6)mmol/L降至术后(10.6±1.1)mmol/L(均P<0.05)。术后中位随访42.4个月(3~93个月),治愈17例,无效1例,1例单纯球囊扩张后术后30 d出现再狭窄,予以置入支架。除1例移植肾动脉出血外无其他并发症。结论移植肾动脉狭窄是导致移植肾失功的常见血管因素,腔内治疗安全、有效。     

同种异体肾移植术后移植肾动脉狭窄 介入治疗的临床疗效分析

目的探讨同种异体肾移植术后移植肾动脉狭窄（TRAS）介入治疗的临床疗效。方法介入治疗同种异体肾移植术后TRAS患者22例,其中单纯球囊扩张治疗10例（球囊组）,内支架治疗12例（支架组）。对所有患者术前及术后2年内血压、肾功能以及生活质量进行评估,并与同期接受单纯药物治疗的6例TRAS患者（药物组）进行比较。结果球囊组技术成功率90.00%,支架组技术成功率100%。术后在血压及肾功能改善方面,球囊组和支架组均取得显著疗效,两组近期疗效未见明显差异,药物组疗效不满意。术后随访6个月～2年,支架组再狭窄率16.67%,除1例不明原因治疗无效外,其余11例均能比较健康的生活和工作。球囊组手术失败1例,再狭窄率达40.00%。结论内支架植入术可作为TRAS特别是I型及Ⅱ型狭窄的首选治疗方法。