Post-kidney transplantation external iliac artery stenosis due to vascular clamp: report of a case

Case report: Endovascular treatment of transplant renal artery stenosis in patient with normal color duplex ultrasound of the renal artery

Key Clinical Message

Proper diagnosis and treatment of vascular stenosis which is a possible complication of renal transplant is important in improving patients' quality of life and prognosis.

Abstract

One known consequence among recipients of renal transplants is graft renal artery stenosis. Early identification and therapy are crucial to avoid graft malfunction and the serious consequences that might arise due to elevated hypertension in several organs. We report a rare case of transplant renal artery stenosis in a mid-aged woman who presented with edema, hypertension, and increased creatinine 2 months after kidney transplant. The patient had normal renal arterial resistive index (RI) and perfusion index (PI), and there was only a modest decrease in perfusion on duplex ultrasound. Following the patient's renal stenting treatment, angiographic resolution was observed. After 14 days of regulated blood pressure following renal artery stenting, she was discharged from the hospital with her edema resolved. Considering complications in patients with clinical manifestations such as hypertension resistant to treatment and graft dysfunction, vascular stenosis is a notable issue to consider even in the context of normal renal arterial RI, PI, and duplex ultrasound. Proper diagnosis and treatment are of importance to improve patients' quality of life and prognosis.

Temporary Clamping of Bilateral Common Iliac Artery During Cesarean Hysterectomy for the Management of Placenta Percreta

OBJECTIVE

To evaluate whether bilateral common iliac artery (CIA) temporary clamping reduces blood loss during cesarean-hysterectomy of placenta percreta cases.

STUDY DESIGN

A total of 32 women, who underwent cesarean-hysterectomy under bilateral CIA temporary clamping (n = 12) and without any arterial clamping or ligation (control group, n = 20) due to placenta percreta in Gaziantep University Hospital were retrospectively evaluated. The intra- and postoperative outcomes such as blood loss, blood transfusion and complications were compared between the two groups.

RESULTS

Age, parity, body-mass-index and gestational-age were similar in the two groups. The estimated blood loss was lower in the temporary clamping of CIA group than the control group (595 ± 172 mL vs 1450 ± 662 mL, P < 0.001). The number of intraoperative packed-red-blood-cells (0.17 ± 0.58 units vs 1.85 ± 1.46 units, P = 0.002) and fresh-frozen-plasma (0.17 ± 0.58 units vs 1.7 ± 1.49 units, P = 0.005) transfusions were lower in the CIA temporary clamping group than the control group. The rate of women, who received blood/blood products were significantly lower in the CIA temporary clamping group compared to the control group (75 % vs 16 %, P = 0.001). Duration of operation was longer in the CIA temporary clamping group (140 ± 38 min vs 90 ± 25 min, p = 0.001). No complication or maternal death was encountered during this study.

CONCLUSION

Bilateral CIA temporary clamping method reduces the intraoperative blood loss and the amount of intraoperative blood/blood product transfusions during cesarean-hysterectomy due to placenta percreta.