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REVIEW ARTICLE
Year : 2012  |  Volume : 6  |  Issue : 3  |  Page : 83-87

Experiences regarding intervention in renal transplantations by nephrologists


1 Consultant Nephrologist, Muljibhai Patel Urological Hospital, Dr. V.V. Desai Road, Nadiad 387001, Gujarat, India
2 Director, Post Graduate Studies and Research, Muljibhai Patel Urological Hospital, Dr. V.V. Desai Road, Nadiad 387001, Gujarat, India

Correspondence Address:
Kalpesh Gohel
Consultant Nephrologist, Muljibhai Patel Urological Hospital, Dr. V.V. Desai Road, Nadiad 387001, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.1016/j.ijt.2012.08.002

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Vascular complications after kidney transplantation occur at a rate of 1–4% cases. The commonest of these complications is graft artery stenosis. It is often detected following difficult to control hypertension and/or graft dysfunction. If detected early usually with the help of duplex Doppler ultrasonography it can be successfully treated by endovascular intervention by suitably trained specialists. Interventions are also needed for post graft biopsy hemorrhage or arterio-venous fistula (AVF). Percutaneous transcatheter fibrated platinum coil embolization super selectively in the artery supplying the AVF can be life saving. It may improve blood pressure control and graft function in selected cases. Other endovascular interventions performed in transplanted kidneys are graft renal angioplasty with or without stenting and placement of covered stent graft. Technological advances in noninvasive imaging like CT angiogram, contrast enhanced Doppler ultrasound and MR angiography have simplified diagnosis and follow up of these patients without compromising safety. At our institute since January 2007, we encountered 8 cases of transplant renal artery stenosis, 6 arteriovenous fistulas and a case of extra and intrarenal pseudo aneurysm. All patients with transplant renal artery stenosis underwent angioplasty and stenting successfully both in terms of anatomical correction and improvement in blood pressure control as well as graft function. One patient had arterial stenosis and arteriovenous fistulas both and he underwent simultaneous stenting and coil embolization. Three patients with fistulas who had significant bleeding underwent successful coil embolization while 2 patients who were asymptomatic are under close surveillance. One patient each who had extra and intrarenal pseudo aneurysm underwent successful endovascular covered stent grafting and multiple coil embolization respectively. Vascular interventions in renal allograft by experienced nephrology unit can achieve good success with minimal complications.


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