Renal transplant arterial stenosis: percutaneous transluminal angioplasty

Seven hypertensive patients underwent percutaneous transluminal angioplasty for relief of arterial stenosis complicating renal allotransplantation. Five had end-to-side anastomosis of the donor renal artery to the recipient external iliac artery, and two had end-to-end anastomosis of the donor renal artery to the recipient internal iliac artery. Each patient had developed hypertension (blood pressure greater than 145/95 mm Hg), elevated peripheral venous plasma renin, and six demonstrated decrease in renal function as detected by an increase in serum creatinine at least 2 months after transplantation and without evidence of rejection. Angioplasty was technically successful without significant complications and blood pressure and biochemical abnormalities were improved or stabilized in all seven patients.     

Renal transplant artery stenosis and percutaneous transluminal angioplasty

Ten patients with renal transplant artery stenosis were treated with percutaneous transluminal angioplasty (PTA). All patients suffered from hypertension refractory to drug treatment. PTA was successful in five patients. Blood pressure improved significantly and the antihypertensive medication could be reduced or withdrawn. Acute angulation at the anastomosis prevented successful PTA in four patients. One inaccessible stenosis was corrected surgically. No significant complications arose. If a renal transplant artery stenosis is haemodynamically significant, PTA should be considered the method of first choice for correction.     

Renal artery stenosis in en-bloc pediatric renal transplant: demonstration by captopril-enhanced renal scintigraphy.

A double-pediatric kidney transplant recipient, who developed hypertension, was found to have unilateral renal artery stenosis. The stenosis was successfully assessed by single-dose 99mTc-diethylenetriaminepentaacetic acid renal scintigraphy, confirmed by renal arteriography, and treated by percutaneous transluminal angioplasty. This case illustrates the usefulness of Captopril-enhanced renography in screening en-bloc transplant patients suspected for renal vascular hypertension.     

Axillary and subclavian vein stenosis: percutaneous angioplasty

Twenty-nine percutaneous balloon dilations of the axillary and subclavian veins were performed in 19 patients. Stenoses occurred in typical locations of anatomic narrowing or at sites of previous trauma. The initial success rate was 76%, with a 1-year patency rate of 35% and a 2-year patency rate of 6%. Angioplasty can be performed on an outpatient basis with a very low rate of significant complications and can be repeated numerous times to keep a vein patent for many years. This procedure is especially valuable in dialysis patients who have limited access sites.     

Renal scintigraphic findings in a case of transplant renal vein thrombosis

Renal vein thrombosis is a rare complication of renal transplantation. The scintigraphic features of a documented case of renal vein thrombosis studied with Tc-99m DTPA and the differential diagnosis relevant to these findings are discussed.     

A complication of percutaneous transluminal angioplasty in the transplanted kidney

The following case report illustrates a complication that can occur as a consequence of implementing percutaneous transluminal angioplasty for correction of renal artery stenosis in a transplanted kidney. Immediately following the procedure, there was severe spasm of upper and lower branches of the renal artery and thrombosis of the arterial supply to the middle portion of the kidney.     

Renal vein thrombosis: an underdiagnosed complication of multiple renal abnormalities.

Thirty-one cases of renal vein thrombosis (RVT) were reviewed retrospectively for clinical laboratory, and radiographic findings. An underlying renal disorder was present in 28 cases, absent in only 3. This supports other evidence that RVT is usually a complication of renal disease rather than a primary event, and that nephrotic syndrome may be due to renal disease rather than RVT. The findings also confirmed the large spectrum of urographic appearances in RVT, and were used as a basis for developing specific and liberal indications for renal venography.     

Spontaneous resolution of a portal vein stenosis over a 21-month period in a "split-liver" transplant: demonstration by colour Doppler ultrasound,catheter angiography and splenic pulp pressures

Portal vein stenosis in a "split-liver" transplant patient is demonstrated on colour Doppler ultrasound and indirect portography with raised splenic pulp pressures which resolves over a 21-month period without surgical or radiological intervention. When a portal vein stenosis in a liver transplant is encountered without severe derangement of liver function tests or signs of portal hypertension, regular follow-up colour Doppler ultrasound surveillance allows for evidence of spontaneous resolution.     

Portal vein stenosis complicating liver transplantation in children: percutaneous transhepatic angioplasty.

Portal vein stenosis complicating orthotopic liver transplantation in children is uncommon. The authors report their early experience with transhepatic portal vein angioplasty in the treatment of portal vein stenosis in this setting. The technique was used in two children (aged 2 and 6 years) who had undergone liver transplantation for biliary atresia 15 and 42 months earlier, respectively. Both patients presented with chronic anemia and intermittent gastrointestinal bleeding. The diagnosis of portal vein stenosis was confirmed at fine-needle splenoportography. Access to the portal venous system was gained by means of a transhepatic approach. Low-profile angioplasty balloon catheters were used to dilate anastomotic strictures of the portal vein in both children. At the end of the procedure, the tract within the liver was occluded with gelatin sponge pledgets. Both procedures were technically successful and caused no complications, and in both patients gastrointestinal bleeding ceased.     

Renal artery stenosis: Changes in intrarenal doppler waveform following percutaneous transluminal angioplasty

Purpose: To examine the extent of the changes in the intrarenal spectral waveform patterns after percutaneous transluminal angioplasty (PTA) and whether there is a correlation with the angiographic and clinical results. Methods: In 44 patients with 68 PTAs we analyzed the intrarenal spectral waveform regarding the existence of a tardus–parvus pattern before and after PTA. Results: In 51 of the 60 cases with a tardus–parvus pattern prior to PTA, a complete normalization of the spectral waveform was noted. There was no correlation between the Doppler result after PTA and the angiographic and clinical result. In contrast there was a significant correlation between the Doppler result before PTA and the clinical outcome: patients with a normal intrarenal spectral waveform before PTA showed no improvement in their arterial hypertension. Conclusion: Our results indicate that a patient with a normal spectral waveform analysis does not response to PTA. However, there is still an unpredictable clinical response even if a patient has an abnormal intrarenal spectral waveform prior to PTA and a complete normalization after PTA.     

Hepatic artery stenosis in liver transplant recipients: primary treatment with percutaneous transluminal angioplasty

PURPOSE: To evaluate the efficacy of hepatic artery percutaneous transluminal angioplasty (PTA) in the treatment of hepatic artery stenosis (HAS). MATERIALS AND METHODS: A retrospective analysis was performed of all cases of HAS documented by angiography from January 1995 to June 2003 at the authors' institution. Management was evaluated and long-term patency was documented by Doppler ultrasonography. The patency, restenosis, and hepatic artery thrombosis (HAT) rates were determined by the Kaplan-Meier method. The technical success of hepatic artery PTA was stratified according to the location of the stenoses relative to the anastomosis, as well as by the presence of associated hepatic arterial kinks. RESULTS: Thrombosis was seen in 65% +/- 13% of untreated HAS cases within 6 months. Stenotic lesions without associated arterial kinks had an improved technical success rate and a reduced complication rate of 94% and 10%, respectively, compared with lesions with associated hepatic arterial kinks treated with hepatic artery PTA (14% and 29%, respectively). The 1-year primary and primary assisted patency rates of hepatic artery PTA for all lesions were 44% +/- 12% and 60% +/- 11%, respectively, and were 65% +/- 10% and 80% +/- 8%, respectively, for lesions not associated with hepatic arterial kinks. The 1-year HAT rate and restenosis rate after hepatic artery PTA were 19% +/- 10% and 32% +/- 11%, respectively. The 1-year primary assisted patency rate for hepatic artery PTA with repeat PTA performed for restenosed lesions and surgical revascularization performed for failed PTA was 74% +/- 10%. CONCLUSIONS: Untreated HAS carries a high morbidity rate. Hepatic artery PTA can play a large role in the management of HAS by reducing the HAT rate more than threefold. With appropriate lesion selection, hepatic artery PTA will have better patency rates than those associated with hepatic artery stent placement.     

Renal abscess: a complication of ethanol embolization

The authors describe a previously unreported complication of ethanol ablation of a renal tumor in one case. A renal abscess developed in a patient with preexisting silent urosepsis 5 weeks following ablation. Routine urinalysis, Gram stain, and urine culture are recommended as preprocedure tests to avoid such complications.     

Vascular percutaneous transcatheter embolisation with a new device: Amplatzer vascular plug

PURPOSE: The aim of this study was to evaluate the effectiveness of the new Amplatzer vascular plug (AVP) for the occlusion of vascular abnormalities and peripheral vessels, especially those with a large diameter. MATERIALS AND METHODS: The new device was used for the occlusion of five internal iliac arteries to prevent retrograde endoleak following endograft repair, three left subclavian arteries for the treatment of type II endoleaks after positioning thoracic aorta stent-grafts, one pulmonary arteriovenous malformation, one haemodialysis fistula in a patient with forearm oedema and one large gastric varix in a patient who had undergone transjugular intrahepatic portosystemic shunt (TIPS) for haemorrhage. RESULTS: The five internal iliac arteries and the three left subclavian arteries were successfully occluded within 8 and 5 min, respectively. The pulmonary arteriovenous fistula was closed within 3 min and percutaneous oxygen saturation rose from 73% to 93%. The haemodialysis fistula was closed with one device within 4 min. The gastric varix was embolised with two AVPs and two coils within 12 min. CONCLUSIONS: The AVP is an effective device for occluding large diameter vascular abnormalities and peripheral vessels. It is inexpensive and enables safe and low-risk embolisation, with saving of time and requiring only low X-ray dose.     

Renal vein renin analysis: Limitations of its use in predicting benefit from percutaneous angioplasty

Two hundred forty-four consecutive patients (mean age 61 years), including 123 who had technically valid renal vein renin (RVR) analysis and 121 without RVR data, underwent technically successful percutaneous renal artery angioplasty (PTRA). They were retrospectively examined to evaluate the utility of RVR analysis in identifying renal hypertension (RVH), predicting benefit from PTRA, and determining if the lack of knowledge of renin levels significantly affected clinical outcome after PTRA. Abnormal RVR values were associated with clinical benefit after PTRA in 62 of 93 patients (67% sensitivity, 20% specificity, 72% positive predictive value). Clinical improvement following PTRA occurred in 31 of 37 patients with normal pre-PTRA RVR values (16% negative predictive value). RVR analysis correctly identified 86 of 117 patients with renovascular hypertension (74% sensitivity, 16% negative predictive value). Improved blood pressure (BP) control occurred in 72% with abnormal RVR analysis and 66% of the 121 patients without RVR data (p>0.1). We conclude that the very low negative predictive value significantly limited the use of RVR analysis in this elderly (mean age 60 years) patient population with a high incidence of mild renal functional impairment (mean serum creatinine 1.4 mg/dl) and bilateral renal artery stenosis (38%). The lack of pre-PTRA renin data did not significantly affect clinical outcome. If RVR data were relied upon as the exclusive selection criterion in patients of this type, many would be prevented from having the benefit of cure or improvement by PTRA.