ENDOVASCULAR MANAGEMENT OF TRANSPLANT RENAL ARTERY STENOSIS: EARLY AND MID-TERM RESULTS

Detalhes bibliográficos
Autor(a) principal: Pinto, Vanda
Data de Publicação: 2021
Outros Autores: Lopez, Noélia, Cardoso, Ana, Henriques, Mickael, Silva, Emanuel, Silvestre, Luís, Baptista, Lucas, Guerra, José, Mendes Pedro, Luís, Ministro, Augusto
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: https://doi.org/10.48750/acv.389
Resumo: OBJECTIVE: Renal graft dysfunction or worsened hypertension in renal transplanted patients may be a manifestation of graft hypoperfusion due to transplant renal artery stenosis (TRAS) or stenosis of iliac arteries proximal to renal transplant (pseudo-TRAS). Endovascular management of TRAS has been increasingly used to preserve renal graft function. With this study, we aim to evaluate the impact of endovascular treatment of TRAS on renal function in the short to medium term. MATERIAL AND METHODS: This is an observational, retrospective, single-center study that included all adult renal transplant patients who underwent endovascular intervention on TRAS between September 2017 and June 2020. Renal graft function was monitored by serum Creatinine (sCr) levels. RESULTS: Thirteen patients were included (53.8% female), with a median age of 57 (21-70) years. Eleven patients (84.6%) presented with graft dysfunction. Ten subjects (76.9%) underwent transluminal angioplasty and stenting of renal artery and three (23,1%) of donor iliac arteries. Most cases (69.2%) were interventioned in the first-year post-transplant. Overall technical success was 100%, with no periprocedural deaths. Overall 30-day morbidity was 15.4%. Median follow-up time was 20.2 (1,3 – 36,3) months. One patient died during follow up and other worsened graft dysfunction, requiring hemodi- alysis and nephrectomy. Reduction in sCr levels was statistically significant in the first postoperative month, compared to preoperative values, but sCR levels were still increased when compared to baseline levels (pre-TRAS diagnosis). CONCLUSIONS: The majority (12/13) of patients showed improvement or stabilization of renal graft function compared to the preoperative period, during the follow-up period, supporting the procedure’s safety. Despite this, most patients did not recover baseline sCr levels, reinforcing the importance of prompt graft revascularization. Delayed diagnosis of TRAS may compromise the benefit of revascularization and prevent full recovery of renal function.
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spelling ENDOVASCULAR MANAGEMENT OF TRANSPLANT RENAL ARTERY STENOSIS: EARLY AND MID-TERM RESULTSTRATAMENTO ENDOVASCULAR DE ESTENOSE DE ARTÉRIA DE TRANSPLANTE RENAL: RESULTADOS A CURTO E MÉDIO PRAZOTransplant Renal Artery Stenosis (TRAS)Endovascular SurgeryEstenose de Artéria de Transplante Renal (EATR)Cirurgia EndovascularOBJECTIVE: Renal graft dysfunction or worsened hypertension in renal transplanted patients may be a manifestation of graft hypoperfusion due to transplant renal artery stenosis (TRAS) or stenosis of iliac arteries proximal to renal transplant (pseudo-TRAS). Endovascular management of TRAS has been increasingly used to preserve renal graft function. With this study, we aim to evaluate the impact of endovascular treatment of TRAS on renal function in the short to medium term. MATERIAL AND METHODS: This is an observational, retrospective, single-center study that included all adult renal transplant patients who underwent endovascular intervention on TRAS between September 2017 and June 2020. Renal graft function was monitored by serum Creatinine (sCr) levels. RESULTS: Thirteen patients were included (53.8% female), with a median age of 57 (21-70) years. Eleven patients (84.6%) presented with graft dysfunction. Ten subjects (76.9%) underwent transluminal angioplasty and stenting of renal artery and three (23,1%) of donor iliac arteries. Most cases (69.2%) were interventioned in the first-year post-transplant. Overall technical success was 100%, with no periprocedural deaths. Overall 30-day morbidity was 15.4%. Median follow-up time was 20.2 (1,3 – 36,3) months. One patient died during follow up and other worsened graft dysfunction, requiring hemodi- alysis and nephrectomy. Reduction in sCr levels was statistically significant in the first postoperative month, compared to preoperative values, but sCR levels were still increased when compared to baseline levels (pre-TRAS diagnosis). CONCLUSIONS: The majority (12/13) of patients showed improvement or stabilization of renal graft function compared to the preoperative period, during the follow-up period, supporting the procedure’s safety. Despite this, most patients did not recover baseline sCr levels, reinforcing the importance of prompt graft revascularization. Delayed diagnosis of TRAS may compromise the benefit of revascularization and prevent full recovery of renal function.OBJETIVOS: A disfunção de enxerto renal e agravamento de hipertensão nos pacientes transplantado renais podem ser manifestações de hipoperfusão do enxerto devido a estenose de artéria de transplante renal (EATR) ou estenose da artéria ilíaca proximal à anastomose do enxerto (pseudo-EATR). O tratamento endovascular de EATR é cada vez mais frequente para manter a função do enxerto. Com este estudo, pretendemos avaliar o impacto do tratamento endovascular de EATR na função renal a curto e médio prazo. MATERIAIS E MÉTODOS: Este é um estudo observacional, retrospetivo, monocêntrico que inclui todos os pacientes transplantados renais adultos submetidos a tratamento endovascular de EATR entre Setembro de 2017 e Junho de 2020. A função renal foi monitorizada através da medição da creatinina sérica (sCr). RESULTADOS: Treze pacientes foram incluídos (53.8% do sexo feminino), com idade média de 57 (21-70) anos. Onze pacientes (84.6%) desenvolveram disfunção de enxerto. Dez pacientes (76.9%) foram submetidos a angioplastia transluminal e colocação de stent na artéria renal do enxerto e três (23.1%) da artéria ilíaca dadora. A maior parte dos casos (69.2%) foram tratados durante o primeiro ano pós transplante. A taxa de sucesso técnico foi de 100%, sem mortalidade periprocedimento. A taxa de morbilidade aos 30 dias foi de 15.4%. O tempo médio de seguimento foi de 20.2 (1.3 – 36.3) meses. Um doente morreu durante o seguimento e outro sofreu agravamento de disfunção do enxerto com necessidade de hemodiálise e nefrectomia. A redução na sCr foi estatisticamente significativa no primeiro mês pós-intervenção, comparado aos valores pré-intervenção, mas a sCr continuou aumentada quando comparada aos níveis basais (pré-diagnóstico de EATR). CONLUSÃO: A maioria dos pacientes (12/13) melhorou ou estabilizou a função renal após a intervenção em relação ao período pré-intervenção, mostrando a eficácia do procedimento. No entanto, a maior parte dos doentes não retornou aos valores basais de sCr, corroborando a importância da revascularização precoce do enxerto. O atraso no diagnóstico de EATR pode comprometer o benefício da revascularização e impedir a recuperação total da função renal.Sociedade Portuguesa de Angiologia e Cirurgia Vascular2021-12-24T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.48750/acv.389oai:ojs.acvjournal.com:article/389Angiologia e Cirurgia Vascular; Vol. 17 No. 3 (2021): September; 238-244Angiologia e Cirurgia Vascular; Vol. 17 N.º 3 (2021): Setembro; 238-2442183-00961646-706Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://acvjournal.com/index.php/acv/article/view/389https://doi.org/10.48750/acv.389http://acvjournal.com/index.php/acv/article/view/389/258Copyright (c) 2021 Angiologia e Cirurgia Vascularinfo:eu-repo/semantics/openAccessPinto, VandaLopez, NoéliaCardoso, AnaHenriques, MickaelSilva, EmanuelSilvestre, LuísBaptista, LucasGuerra, JoséMendes Pedro, LuísMinistro, Augusto2022-05-23T15:10:12Zoai:ojs.acvjournal.com:article/389Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T14:57:44.606368Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv ENDOVASCULAR MANAGEMENT OF TRANSPLANT RENAL ARTERY STENOSIS: EARLY AND MID-TERM RESULTS
TRATAMENTO ENDOVASCULAR DE ESTENOSE DE ARTÉRIA DE TRANSPLANTE RENAL: RESULTADOS A CURTO E MÉDIO PRAZO
title ENDOVASCULAR MANAGEMENT OF TRANSPLANT RENAL ARTERY STENOSIS: EARLY AND MID-TERM RESULTS
spellingShingle ENDOVASCULAR MANAGEMENT OF TRANSPLANT RENAL ARTERY STENOSIS: EARLY AND MID-TERM RESULTS
Pinto, Vanda
Transplant Renal Artery Stenosis (TRAS)
Endovascular Surgery
Estenose de Artéria de Transplante Renal (EATR)
Cirurgia Endovascular
title_short ENDOVASCULAR MANAGEMENT OF TRANSPLANT RENAL ARTERY STENOSIS: EARLY AND MID-TERM RESULTS
title_full ENDOVASCULAR MANAGEMENT OF TRANSPLANT RENAL ARTERY STENOSIS: EARLY AND MID-TERM RESULTS
title_fullStr ENDOVASCULAR MANAGEMENT OF TRANSPLANT RENAL ARTERY STENOSIS: EARLY AND MID-TERM RESULTS
title_full_unstemmed ENDOVASCULAR MANAGEMENT OF TRANSPLANT RENAL ARTERY STENOSIS: EARLY AND MID-TERM RESULTS
title_sort ENDOVASCULAR MANAGEMENT OF TRANSPLANT RENAL ARTERY STENOSIS: EARLY AND MID-TERM RESULTS
author Pinto, Vanda
author_facet Pinto, Vanda
Lopez, Noélia
Cardoso, Ana
Henriques, Mickael
Silva, Emanuel
Silvestre, Luís
Baptista, Lucas
Guerra, José
Mendes Pedro, Luís
Ministro, Augusto
author_role author
author2 Lopez, Noélia
Cardoso, Ana
Henriques, Mickael
Silva, Emanuel
Silvestre, Luís
Baptista, Lucas
Guerra, José
Mendes Pedro, Luís
Ministro, Augusto
author2_role author
author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Pinto, Vanda
Lopez, Noélia
Cardoso, Ana
Henriques, Mickael
Silva, Emanuel
Silvestre, Luís
Baptista, Lucas
Guerra, José
Mendes Pedro, Luís
Ministro, Augusto
dc.subject.por.fl_str_mv Transplant Renal Artery Stenosis (TRAS)
Endovascular Surgery
Estenose de Artéria de Transplante Renal (EATR)
Cirurgia Endovascular
topic Transplant Renal Artery Stenosis (TRAS)
Endovascular Surgery
Estenose de Artéria de Transplante Renal (EATR)
Cirurgia Endovascular
description OBJECTIVE: Renal graft dysfunction or worsened hypertension in renal transplanted patients may be a manifestation of graft hypoperfusion due to transplant renal artery stenosis (TRAS) or stenosis of iliac arteries proximal to renal transplant (pseudo-TRAS). Endovascular management of TRAS has been increasingly used to preserve renal graft function. With this study, we aim to evaluate the impact of endovascular treatment of TRAS on renal function in the short to medium term. MATERIAL AND METHODS: This is an observational, retrospective, single-center study that included all adult renal transplant patients who underwent endovascular intervention on TRAS between September 2017 and June 2020. Renal graft function was monitored by serum Creatinine (sCr) levels. RESULTS: Thirteen patients were included (53.8% female), with a median age of 57 (21-70) years. Eleven patients (84.6%) presented with graft dysfunction. Ten subjects (76.9%) underwent transluminal angioplasty and stenting of renal artery and three (23,1%) of donor iliac arteries. Most cases (69.2%) were interventioned in the first-year post-transplant. Overall technical success was 100%, with no periprocedural deaths. Overall 30-day morbidity was 15.4%. Median follow-up time was 20.2 (1,3 – 36,3) months. One patient died during follow up and other worsened graft dysfunction, requiring hemodi- alysis and nephrectomy. Reduction in sCr levels was statistically significant in the first postoperative month, compared to preoperative values, but sCR levels were still increased when compared to baseline levels (pre-TRAS diagnosis). CONCLUSIONS: The majority (12/13) of patients showed improvement or stabilization of renal graft function compared to the preoperative period, during the follow-up period, supporting the procedure’s safety. Despite this, most patients did not recover baseline sCr levels, reinforcing the importance of prompt graft revascularization. Delayed diagnosis of TRAS may compromise the benefit of revascularization and prevent full recovery of renal function.
publishDate 2021
dc.date.none.fl_str_mv 2021-12-24T00:00:00Z
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status_str publishedVersion
dc.identifier.uri.fl_str_mv https://doi.org/10.48750/acv.389
oai:ojs.acvjournal.com:article/389
url https://doi.org/10.48750/acv.389
identifier_str_mv oai:ojs.acvjournal.com:article/389
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv http://acvjournal.com/index.php/acv/article/view/389
https://doi.org/10.48750/acv.389
http://acvjournal.com/index.php/acv/article/view/389/258
dc.rights.driver.fl_str_mv Copyright (c) 2021 Angiologia e Cirurgia Vascular
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Copyright (c) 2021 Angiologia e Cirurgia Vascular
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Sociedade Portuguesa de Angiologia e Cirurgia Vascular
publisher.none.fl_str_mv Sociedade Portuguesa de Angiologia e Cirurgia Vascular
dc.source.none.fl_str_mv Angiologia e Cirurgia Vascular; Vol. 17 No. 3 (2021): September; 238-244
Angiologia e Cirurgia Vascular; Vol. 17 N.º 3 (2021): Setembro; 238-244
2183-0096
1646-706X
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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