Sage Journals: Discover world-class research

Abstract

Background

Transplant renal artery stenosis (TRAS) is an uncommon complication following renal transplantation. Its usual clinical presentation includes worsening hypertension and/or renal function, without any evidence of graft rejection. Bifurcation renal artery stenosis of the transplanted renal artery is rarely encountered.

Methods

Percutaneous transluminal renal angioplasty (PTRA) with or without stenting is the procedure of choice to treat TRAS. We hereby describe a patient, who presented with impaired renal functions, four months following the renal transplantation. He underwent intravascular ultrasound-guided PTRA of the bifurcation lesion of TRAS.

Results and conclusion: Superior renal artery had coronary drug-eluting stent implantation, while inferior renal artery and side branch of the superior renal artery had balloon angioplasty, alone. Post-intervention, the raised serum creatinine level decreased from 2.9 mg% to 1.7 mg%. The index case described the successful PTRA and stenting of the bifurcation lesion of TRAS, the technical results of which was optimized with the use of intravascular ultrasound.

Keywords

Bifurcation lesion drug-eluting stent intravascular ultrasound renal transplantation transplant renal artery stenosis

Get full access to this article

View all access options for this article.

References

Roberts

Ascher

Fryd

, et al. Transplant renal artery stenosis. Transplantation 1989; 48: 580–583.

Hurst

Abbott

Neff

, et al. Incidence, predictors and outcomes of transplant renal artery stenosis after kidney transplantation: analysis of USRDS. Am J Nephrol 2009; 30: 459–467.

Patel

Jindal

Wilkin

, et al. Renal arterial stenosis in renal allografts: Retrospective study of predisposing factors and outcome after percutaneous transluminal angioplasty. Radiology 2001; 219: 663–667.

Lian

Da Chang

, et al. Long-term outcomes of patients treated with primary stenting for transplant renal artery stenosis: a 10-year case cohort study. World J Surg 2012; 36: 222–228.

Baus

Radermacher

Galanski

, et al. Kissing balloon technique for angioplasty of renal artery bifurcation stenoses. J Vasc Interv Radiol 2003; 14: 1455–1459.

Fervenza

Lafayette

Alfrey

, et al. Renal artery stenosis in kidney transplants. Am J Kidney Dis 1998; 31: 142–148.

Agüera Fernández

Zudaire

Isa

, et al. Vascular complications in 237 recipients of renal transplant from cadaver. Actas Urol Esp 1992; 16: 292–295.

Ford

McCartney

Corcoran

, et al. Single- versus 2-stent strategies for coronary bifurcation lesions: A systematic review and meta-analysis of randomized trials with long-term follow-up. J Am Heart Assoc 2018; 7: e008730.

Yan

Zheng

, et al. Two-stent strategy for renal artery stenosis with bifurcation lesion. J Zhejiang Univ Sci B 2010; 11: 561–567.

10.

Chaudhry

Nachimuthu

Latif

Percutaneous intervention of two right renal arteries using two guide catheters simultaneously. Vasc Dis Manag 2012; 9: E42–E44.

11.

Sethi

Bahekar

Bhuriya

, et al. Drug-eluting stents versus bare metal stents in ST elevation myocardial infarction at a follow-up of three years or longer: a meta-analysis of randomized trials. Exp Clin Cardiol 2012; 17: 169–174.

12.

Hanna

Hao

Kraus

, et al. Renal transplant arterial stenosis treated with bare-metal versus drug-eluting stents: comparison of treatment outcomes. Transplant Proc 2015; 47: 2881–2885.

13.

Estrada

Musani

Darras

, et al. 5 years experience with drug eluting and bare metal stents as primary intervention in transplant renal artery Stenosis. Transplant Direct 2017; 3: e128.

14.

Sheikh

Anantha-Narayanan

Smolderen

, et al. Utility of intravascular ultrasound in peripheral vascular interventions: systematic review and meta-analysis. Vasc Endovascular Surg 2020; 54: 413–422.

15.

Dangas

Laird

Mehran

, et al. Intravascular ultrasound-guided renal artery stenting. J Endovasc Ther 2001; 8: 238–247.

16.

Leertouwer

Gussenhoven

Van Dijk

, et al. Intravascular ultrasound evidence for coarctation causing symptomatic renal artery stenosis. Circulation 1999; 99: 2976–2978.

17.

Yoshida

Kitauchi

Yoneda

, et al. Metal stent placement for two patients with post-transplantation renal artery stenosis, using intravascular ultrasound imaging. Clin Exp Nephrol 2004; 8: 155–159.

18.

Erwin

Goel

Gebreselassie

, et al. Restoration of renal allograft function via reduced-contrast percutaneous revascularization of transplant renal artery stenosis. Tex Heart Inst J 2015; 42: 80–83.

19.

Kadoya

Zen

Matoba

Endovascular treatment of transplant renal artery stenosis based on hemodynamic assessment using a pressure wire: a case report. BMC Cardiovasc Disord 2018; 18: 172.

20.

Touma

Costanzo

Boura

, et al. Endovascular management of transplant renal artery stenosis. J Vasc Surg 2014; 59: 1058–1065.

21.

Lederman

Mendelsohn

Santos

, et al. Primary renal artery stenting: characteristics and outcomes after 363 procedures. Am Heart J 2001; 142: 314–323.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

Intravascular ultrasound-supported percutaneous angioplasty of post-kidney transplant renal artery bifurcation stenosis