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Tailoring the Endovascular Management of Transplant Renal Artery Stenosis
Author(s) -
Biederman D. M.,
Fischman A. M.,
Titano J. J.,
Kim E.,
Patel R. S.,
Nowakowski F. S.,
Florman S.,
Lookstein R. A.
Publication year - 2015
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.13105
Subject(s) - medicine , stent , renal function , creatinine , stenosis , angioplasty , hemodialysis , blood pressure , anastomosis , renal artery , percutaneous , surgery , cardiology , kidney
In this study we analyze the different types of endovascular interventions (EVIs) in de novo transplant renal artery stenosis (TRAS) and its anatomical subtypes to examine any variation in recovery of allograft function, blood pressure control, EVI patency and allograft survival with respect to EVI type (DES: drug‐eluting stent, BMS: bare‐metal stent, PTA: percutaneous transluminal angioplasty). Forty‐five patients underwent a total of 50 primary EVIs (DES: 18, BMS: 26, PTA: 6). Patients were stratified according to medical co‐morbidities, graft characteristics, biopsy results, clinical presentation and TRAS anatomic subtypes (anastomotic: 26, postanastomotic: 17, bend‐kink: 2). There was significant improvement in allograft function and mean arterial blood pressure (MAP) control across all interventions (pre‐EVI‐creatinine [CR]: 2.8 ± 1.4, post‐EVI‐Cr: 2.1 ± 0.7, p < 0.001; pre‐EVI‐MAP: 117 ± 16, post‐EVI‐MAP: 112 ± 17, p = 0.03) with no significant difference among EVI types. There was no significant difference in allograft survival with respect to EVI type. Patency was significantly higher in EVIs performed with DES and BMS compared to PTA (p = 0.001). In the postanastomotic TRAS subtype, patency rates were significantly higher in DES compared to BMS (p = 0.012) in vessels of comparable reference diameter (≤5 mm).