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Tripathy TP, Fatima K, Patel RK, Alagappan A, Singh J, Mohakud S, Das MK, Nayak P. Emergency endovascular and percutaneous urological interventions: A pictorial review. Emerg Radiol 2024:10.1007/s10140-024-02241-1. [PMID: 38755482 DOI: 10.1007/s10140-024-02241-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024]
Abstract
Emergency endovascular and percutaneous urological interventions encompass various diagnostic and therapeutic procedures to address various genitourinary conditions. These urological interventions are life-saving in addressing complications following biopsy, post-nephrectomy, post-transplant, and post-trauma. Compared to other surgical fields, there are relatively fewer urological emergencies. However, they require prompt radiological diagnosis and urgent interventions. This pictorial essay emphasizes various urological emergencies and urgent interventional management.
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Affiliation(s)
| | - Kaneez Fatima
- Department of Radiodiagnosis, AIIMS, Bhubaneswar, India
| | - Ranjan Kumar Patel
- Department of Radiodiagnosis, AIIMS, Bhubaneswar, India.
- Department of Urology, AIIMS, Bhubaneswar, India.
| | | | - Jitender Singh
- Max Hospitals, Department of Interventional Radiology, Delhi, India
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Prasad S, Singh V, Yachha M, Phadke R, Bhadauria D. Endovascular management of vascular complications in renal allograft - An observational study. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_15_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Sorrells WS, Mao SA, Taner T, Jadlowiec CC, Farres H, Davila V, Money SR, Stone WM, Al-Khasawneh M, Da Rocha-Franco JADR, Oldenburg WA, Oderich GS, Taner CB, Hakaim AG, Erben Y. Endarterectomy for Iliac Occlusive Disease during Kidney Transplantation: A Multicenter Experience. Int J Angiol 2020; 30:91-97. [PMID: 34054266 DOI: 10.1055/s-0040-1714752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Little is known about the surgical challenges and outcomes of kidney transplantation (KT) in the face of severe iliac occlusive disease (IOD). We aim to examine our institution's experience and outcomes compared with all KT patients. Retrospective review of our multi-institutional transplant database identified patients with IOD requiring vascular surgery involvement for iliac artery endarterectomy at time of KT from 2000 to 2018. Clinical data, imaging studies, and surgical outcomes of 22 consecutive patients were reviewed. Our primary end-point was allograft survival. Secondary end-points included mortality and perioperative complications. A total of 6,757 KT were performed at our three sites (Florida, Arizona, and Minnesota); there were 22 (0.32%) patients receiving a KT with concomitant IOD requiring iliac artery endarterectomy. Mean patient age was 61.45 ± 7 years. There were 13 (59.1%) male patients. The most common etiology of renal failure was diabetic nephropathy in 10 patients (45.5%) followed by a combination of hypertensive/diabetic nephropathy in five patients (22.7%), and hypertensive nephrosclerosis in three patients (13.6%). The majority ( n = 16, 72.7%) of patients received renal allografts from deceased donors and six (27.3%) were recipients from living donors. Mean time from dialysis to transplantation was 2.9 ± 2.9 years. Mean follow-up was 3.5 ± 2.5 years. Mean length of hospital stay was 6.3 ± 4.3 days (range: 3-18 days). Graft loss within 90 days occurred in two (9.1%) patients, one due to renal vein thrombosis and another due to acute tubular necrosis. Overall allograft survival was 90.1% at 1-year and 86.4% at 3-year follow-up. Overall mortality occurred in 6 (27.3%) patients. Perioperative complications (Clavien-Dindo Grade 2-4) occurred in 13 (59.1%) patients, including 10 (45.5%) with acute blood loss anemia requiring transfusion, 2 (9.1%) reoperations for hematoma evacuation, 1 (4.5%) ischemic colitis requiring total abdominal colectomy, and 1 (4.5%) renal vein thrombosis requiring nephrectomy. IOD patients selected for KT are not common and although challenging, they have similar outcomes to our standard KT patients. The 1- and 3-year allograft survivals were 90.1 and 86.4% versus 96.0 and 90.3% in the general KT patient population. With these excellent outcomes, we recommend expanding the criteria for KT to include patients with IOD with prior vascular surgery consultation to prevent progression of IOD or prevention of wait list removal in select patients who are otherwise good candidates for KT.
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Affiliation(s)
- William S Sorrells
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida
| | - Shennen A Mao
- Division of Transplantation Surgery, Mayo Clinic, Jacksonville, Florida
| | - Timucin Taner
- Division of Transplantation Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Houssam Farres
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida
| | - Victor Davila
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Scottsdale, Arizona
| | - Samuel R Money
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Scottsdale, Arizona
| | - William M Stone
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Scottsdale, Arizona
| | | | | | - Warner A Oldenburg
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida
| | - Gustavo S Oderich
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - C Burcin Taner
- Division of Transplantation Surgery, Mayo Clinic, Jacksonville, Florida
| | - Albert G Hakaim
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida
| | - Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida
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McEnaney RM, Go C, Li X, Eslami MH. Endovascular management of complete disruption of aortic anastomosis after pediatric multivisceral transplant. J Vasc Surg Cases Innov Tech 2020; 6:331-336. [PMID: 32715166 PMCID: PMC7371609 DOI: 10.1016/j.jvscit.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/05/2020] [Indexed: 01/16/2023] Open
Abstract
Multivisceral transplantation is a life-saving treatment for many chronically ill patients with advanced abdominal pathologies. For such transplants, a complex arterial reconstruction is required, with numerous anastomoses on a composite donor graft and the native aorta. In these patients, anastomotic disruption or pseudoaneurysm formation, often in the setting of infection, are deadly complications. Open surgical repair is hazardous, because many of these patients have dense adhesions. Reported cases of disruption at the aortic anastomosis to date have resulted in patient demise. We report the case of a pediatric multivisceral transplant recipient with ruptured aortic pseudoaneurysm. He underwent an emergent endovascular parallel stent grafting technique, which successfully controlled bleeding and maintained graft perfusion.
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Affiliation(s)
- Ryan M. McEnaney
- Correspondence: Ryan M. McEnaney, MD, University of Pittsburgh Medical Center, Vascular Surgery, 200 Lothrop Street, Pittsburgh, PA 15213-2582
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Uğurlucan M, Önal Y, Öztaş DM, Odabaş AR, Alpagut U. Transplanted kidney, stenotic renal artery, and a giant pseudoaneurysm: How we tried to treat, Why we failed, and How we managed? TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2019; 27:114-117. [PMID: 32082837 PMCID: PMC7021360 DOI: 10.5606/tgkdc.dergisi.2019.16492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 11/11/2018] [Indexed: 11/21/2022]
Abstract
Donor and recipient artery problems are challenging complications in renal transplant patients. In this report, we present our treatment strategy in a 42-year-old renal transplant case with renal artery stenosis and a giant pseudoaneurysm at the anastomotic site. Open repair failed due to extreme adhesions. However, the patient was managed successfully using the hybrid approach with iliofemoral bypass and stent graft implantation to the renal artery, providing retrograde renal artery perfusion.
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Affiliation(s)
- Murat Uğurlucan
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Yılmaz Önal
- Department of Radiology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Didem Melis Öztaş
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Ali Rıza Odabaş
- Department of Urology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Ufuk Alpagut
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
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Taffel MT, Nikolaidis P, Beland MD, Blaufox MD, Dogra VS, Goldfarb S, Gore JL, Harvin HJ, Heilbrun ME, Heller MT, Khatri G, Preminger GM, Purysko AS, Smith AD, Wang ZJ, Weinfeld RM, Wong-You-Cheong JJ, Remer EM, Lockhart ME. ACR Appropriateness Criteria ® Renal Transplant Dysfunction. J Am Coll Radiol 2018; 14:S272-S281. [PMID: 28473084 DOI: 10.1016/j.jacr.2017.02.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 02/06/2023]
Abstract
Renal transplantation is the treatment of choice in patients with end-stage renal disease because the 5-year survival rates range from 72% to 99%. Although graft survival has improved secondary to the introduction of newer immunosuppression drugs and the advancements in surgical technique, various complications still occur. Ultrasound is the first-line imaging modality for the evaluation of renal transplants in the immediate postoperative period and for long-term follow-up. In addition to depicting many of the potential complications of renal transplantation, ultrasound can also guide therapeutic interventions. Nuclear medicine studies, CT, and MRI are often helpful as complementary examinations for specific indications. Angiography remains the reference standard for vascular complications and is utilized to guide nonsurgical intervention. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Myles T Taffel
- Principal Author, George Washington University Hospital, Washington, District of Columbia.
| | - Paul Nikolaidis
- Panel Vice-chair, Northwestern University, Chicago, Illinois
| | | | - M Donald Blaufox
- Albert Einstein College of Medicine, Bronx, New York; Society of Nuclear Medicine and Molecular Imaging
| | - Vikram S Dogra
- University of Rochester Medical Center, Rochester, New York
| | - Stanley Goldfarb
- University of Pennsylvania School of Medicine, Philadelphia; Pennsylvania, American Society of Nephrology
| | - John L Gore
- University of Washington, Seattle, Washington; American Urological Association
| | | | | | | | | | - Glenn M Preminger
- Duke University Medical Center, Durham, North Carolina; American Urological Association
| | | | - Andrew D Smith
- The University of Mississippi Medical Center, Jackson, Mississippi
| | - Zhen J Wang
- University of California San Francisco School of Medicine, San Francisco, California
| | - Robert M Weinfeld
- Oakland University William Beaumont School of Medicine, Troy, Michigan
| | | | | | - Mark E Lockhart
- Panel Chair, University of Alabama at Birmingham, Birmingham, Alabama
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Valle LG, Cavalcante RN, Motta-Leal-Filho JM, Affonso BB, Galastri FL, Doher MP, Guimarães-Souza NK, Cavalcanti AK, Garcia RG, Pacheco-Silva Á, Nasser F. Evaluation of the efficacy and safety of endovascular management for transplant renal artery stenosis. Clinics (Sao Paulo) 2017; 72:773-779. [PMID: 29319724 PMCID: PMC5738562 DOI: 10.6061/clinics/2017(12)09] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/17/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To evaluate the safety and efficacy of endovascular intervention with angioplasty and stent placement in patients with transplant renal artery stenosis. METHODS All patients diagnosed with transplant renal artery stenosis and graft dysfunction or resistant systemic hypertension who underwent endovascular treatment with stenting from February 2011 to April 2016 were included in this study. The primary endpoint was clinical success, and the secondary endpoints were technical success, complication rate and stent patency. RESULTS Twenty-four patients with transplant renal artery stenosis underwent endovascular treatment, and three of them required reinterventions, resulting in a total of 27 procedures. The clinical success rate was 100%. All graft dysfunction patients showed decreased serum creatinine levels and improved estimated glomerular filtration rates and creatinine levels. Patients with high blood pressure also showed improved control of systemic blood pressure and decreased use of antihypertensive drugs. The technical success rate of the procedure was 97%. Primary patency and assisted primary patency rates at one year were 90.5% and 100%, respectively. The mean follow-up time of patients was 794.04 days after angioplasty. CONCLUSION Angioplasty with stent placement for the treatment of transplant renal artery stenosis is a safe and effective technique with good results in both the short and long term.
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Affiliation(s)
- Leonardo G.M. Valle
- Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Rafael N. Cavalcante
- Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
| | | | - Breno B. Affonso
- Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
| | - Francisco L. Galastri
- Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
| | - Marisa P. Doher
- Departamento de Nefrologia, Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
| | | | - Ana K.N. Cavalcanti
- Departamento de Nefrologia, Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
| | - Rodrigo G. Garcia
- Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
| | - Álvaro Pacheco-Silva
- Departamento de Nefrologia, Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
| | - Felipe Nasser
- Departamento de Radiologia Intervencionista, Hospital Israelita Albert Einstein, Sao Paulo, SP, BR
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Vascular Augmentation in Renal Transplantation: Supercharging and Turbocharging. Arch Plast Surg 2017; 44:238-242. [PMID: 28573100 PMCID: PMC5447535 DOI: 10.5999/aps.2017.44.3.238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 01/16/2017] [Accepted: 03/28/2017] [Indexed: 11/23/2022] Open
Abstract
The most common anatomic variant seen in donor kidneys for renal transplantation is the presence of multiple renal arteries, which can cause an increased risk of complications. Accessory renal arteries should be anastomosed to the proper source arteries to improve renal perfusion via the appropriate vascular reconstruction techniques. In microsurgery, 2 kinds of vascular augmentation methods, known as ‘supercharging’ and ‘turbocharging,’ have been introduced to ensure vascular perfusion in the transferred flap. Supercharging uses a distant source of the vessels, while turbocharging uses vascular sources within the same flap territory. These technical concepts can also be applied in renal transplantation, and in this report, we describe 2 patients who underwent procedures using supercharging and turbocharging. In one case, the ipsilateral deep inferior epigastric artery was transposed to the accessory renal artery (supercharging), and in the other case, the accessory renal artery was anastomosed to the corresponding main renal artery with a vascular graft (turbocharging). The transplanted kidneys showed good perfusion and proper function. No cases of renal failure, hypertension, rejection, or urologic complications were observed. These microsurgical techniques can be safely utilized for renal transplantation with donor kidneys that have multiple arteries with a lower complication rate and better outcome.
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Carpenter DJ, Mohan S, Ratner LE, Schlossberg P. Combined Percutaneous Transrenal and Transfemoral Endovascular Recanalization and Angioplastic Reconstruction of a Disrupted Transplant Renal Artery Stent: A Novel Salvage Technique. Am J Transplant 2017; 17:1119-1124. [PMID: 27862938 PMCID: PMC5484052 DOI: 10.1111/ajt.14115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/12/2016] [Accepted: 11/02/2016] [Indexed: 01/25/2023]
Abstract
Renal artery stenosis is the most common vascular complication following renal transplantation. Percutaneous endovascular transluminal angioplasty with stenting is the treatment of choice for clinically significant renal artery stenosis. The authors present a case describing a novel combined transrenal parenchyma and transfemoral approach to repairing a disrupted transplant renal artery stent. The patient's allograft renal artery stenosis was initially managed via the standard percutaneous approach, but during follow-up the stent became disrupted and crushed, causing partial occlusion of the renal artery. This was manifested by persistently elevated serum creatinine values, lower extremity edema, and four-medication hypertension. After a failed traditional percutaneous transfemoral attempt, the authors were able to successfully access the renal arterial system via a combined transrenal and transfemoral approach, using an upper-pole artery through the renal parenchyma. This transrenal approach used a 3 Fr system, allowing the authors to get a wire across the stent, which they were previously unable to do. With wire access, they performed a balloon angioplastic reconstruction to restore the stent's patency, resulting in a reduction in serum creatinine, lower extremity edema, and blood pressure. This technique avoided a potentially difficult reoperative repair without immediate complication and provides a method for vascular access to the renal arterial system in select patients.
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Affiliation(s)
- Dustin J. Carpenter
- Department of Surgery, Division of General Surgery, Columbia University Medical Center, New York, New York
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York,The Columbia University Renal Epidemiology (CURE) Group, New York, New York
| | - Lloyd E. Ratner
- Department of Surgery, Division of Transplantation, Columbia University Medical Center, New York, New York
| | - Peter Schlossberg
- Department of Radiology, Division of Interventional Radiology, Columbia University Medical Center, New York, New York
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Zhang X, Wang H, Liu S, Yan J, Liu X, Xu D, Tian C. Three-Dimensional Computed Tomography Reconstruction in Transplant Renal Artery Stenosis. EXP CLIN TRANSPLANT 2017; 15:615-619. [PMID: 28332957 DOI: 10.6002/ect.2016.0156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Transplant renal artery stenosis is a frequently recognized complication of kidney transplant procedures. A single-center retrospective study was conducted to examine the use of 3-dimensional computed tomography reconstruction in diagnosing transplant artery stenosis. MATERIALS AND METHODS During 2013 at our center, 86 patients underwent kidney transplant. All patients underwent ultrasonographic analyses. Patients with clinically suspected transplant renal artery stenosis were examined by 3-dimensional computed tomography reconstruction and were treated with endovascular approaches or medically managed. RESULTS Ten patients were diagnosed with transplant renal artery stenosis by 3-dimensional computed tomography reconstruction. No evidence of contrast-induced nephrotoxicity was observed. Nine of the 10 patients underwent percutaneous transluminal angio-plasty, whereas the remaining patient was treated conservatively. Procedural success rate was 100%. Patients were followed for a mean period of 20 ± 3 months. Blood pressure improved from a mean of 163/90 to 132/73 mm Hg at the end of the follow-up period. In the 9 patients who underwent angioplasty, serum creatinine improved from 198 ± 24 to 134 ± 16 μmol/L at the end of the follow-up period. The cystatin C level in some patients declined after interventional therapy. CONCLUSIONS Three-dimensional computed tomography reconstruction is a safe choice for patients who present with increased serum creatinine levels and refractory hypertension. Percutaneous transluminal angioplasty is the preferred therapeutic technique for transplant renal artery stenosis.
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Affiliation(s)
- Xufeng Zhang
- Department of Kidney Transplantation, Second Hospital of Shandong University, Jinan 250000, China
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Lorentz LA, Hlabangana LT, Davies M. A Case of Intraparenchymal Pseudoaneurysms in Kidney Allograft. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:570-3. [PMID: 27510594 PMCID: PMC4991616 DOI: 10.12659/ajcr.897968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient: Male, 31 Final Diagnosis: Intraparenchymal pseudo-aneurysms in kidney transplant Symptoms: Asymptomatic Medication: — Clinical Procedure: Percutaneous renal biopsy Specialty: Transplantology
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Affiliation(s)
- Liam Antony Lorentz
- Department of Radiology, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Malcom Davies
- Department of Nephrology, University of the Witwatersrand, Johannesburg, South Africa
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Patil VV, Roytman M, Ames S, Beckerman W, Lookstein RA. Endovascular Repair of Renal Artery Anastomotic Pseudoaneurysm Following Living Donor Kidney Transplant. Cardiovasc Intervent Radiol 2015; 38:1640-4. [PMID: 26037091 DOI: 10.1007/s00270-015-1136-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/01/2015] [Indexed: 02/06/2023]
Abstract
Renal artery anastomotic pseudoaneurysms, an uncommon complication of transplantation, may result in aneurysm rupture and loss of allograft. We report the case of 50-year-old female with back pain 3 weeks post renal transplantation. CT scan revealed transplant renal artery anastomotic pseudoaneurysm arising from anastomosis of two renal arteries joined together to form a single renal artery that was joined to the aorta. Successful endovascular treatment was achieved with covered stents, resulting in preserved renal function. Follow-up ultrasound at one-day post procedure and CT at 2 months revealed satisfactory renal perfusion with no pseudoaneurysm. Endovascular treatment of transplant renal artery pseudoaneurysms with covered stent and ostial flare balloon technology may be preferred in patients with extensive prior pelvic surgery, as illustrated in this case.
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Affiliation(s)
- Vivek V Patil
- Division of Interventional Radiology, Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, 10029, NY, USA.
| | - Michelle Roytman
- Division of Interventional Radiology, Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, 10029, NY, USA.
| | - Scott Ames
- Department of Surgery, Recanati Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, 10029, NY, USA.
| | - William Beckerman
- Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, 10029, NY, USA.
| | - Robert A Lookstein
- Division of Interventional Radiology, Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1234, New York, 10029, NY, USA.
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