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Vu VH, Nguyen NT, Nguyen CD, Nguyen KD, Truong BQ. Endovascular intervention with intravascular ultrasound guidance of very early dissection complication in transplant renal artery: a case report and literature review. Front Cardiovasc Med 2024; 11:1396998. [PMID: 38841260 PMCID: PMC11150689 DOI: 10.3389/fcvm.2024.1396998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024] Open
Abstract
Background Transplant renal artery dissection (TRAD) is a rare and serious event that can cause allograft dysfunction and eventually graft loss. Most cases are managed by operative repair. We report a case of TRAD in the early postoperative period, which was successfully managed with intravascular ultrasound-assisted endovascular intervention. Case presentation A 38-year-old man underwent HLA-compatible living kidney transplantation. The allograft had one renal artery and vein, which were anastomosed to the internal iliac artery and external iliac vein, respectively. Doppler ultrasonography performed a day after the operation showed an increase in systolic blood velocity, with no observed urine output and raising a suspicion of arterial anastomotic stenosis. Angiography showed a donor renal artery dissection distal to the moderately stenosed anastomosis site with calcified atherosclerotic plaque confirmed by IVUS. The transplant renal artery lesion was intervened with a stent. After the intervention, Doppler US revealed that the blood flow of the renal artery was adequate without an increase in the systolic blood velocity. Urine output gradually returned after 3 weeks, and serum creatinine level was normalized after 2 months. Conclusions Transplant recipients commonly have atherosclerosis and hypertension, which are risk factors for arterial dissection. Our case showed that endovascular intervention can replace surgery to repair very early vascular complications such as dissection and help patients avoid high-risk operations. Early diagnosis and IVUS-assisted intervention with experienced interventionists can save allograft dysfunction.
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Affiliation(s)
- Vu Hoang Vu
- Medicine Faculty, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Interventional Cardiology Department, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nghia Thuong Nguyen
- Interventional Cardiology Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Chinh Duc Nguyen
- Cardiovascular Center, Can Tho Stroke International Services, Can Tho, Vietnam
| | - Khang Duong Nguyen
- Interventional Cardiology Department, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Binh Quang Truong
- Medicine Faculty, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Interventional Cardiology Department, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Zhang J, Xue W, Tian P, Zheng J, Ding C, Li Y, Wang Y, Ding X. Diagnostic and therapeutic strategies for vascular complications after renal transplantation: a single-center experience in 2,304 renal transplantations. FRONTIERS IN TRANSPLANTATION 2023; 2:1150331. [PMID: 38993913 PMCID: PMC11235313 DOI: 10.3389/frtra.2023.1150331] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/14/2023] [Indexed: 07/13/2024]
Abstract
Vascular complications after renal transplantation are one of the serious surgical complications, which can affect the transplantation outcome and even endanger life if not treated properly. We performed a retrospective analysis of the 2,304 renal transplantations procedures completed between the period of Jan., 2015 and Jan., 2022, which consisted of 1,658 male patients and 646 female patients. Among the above cases, there were 54 cases of vascular complications after renal transplantation, the incidence of vascular complications in our study was 2.34% (54/2,304), the most common vascular complication was transplanted renal artery stenosis (TRAS, n = 36), followed by external iliac artery dissection (n = 5), renal artery rupture (n = 4), renal vein thrombosis (n = 3), renal artery thrombosis (n = 2), renal artery dissection (n = 1), renal artery pseudoaneurysm (n = 1), and internal iliac artery pseudoaneurysm (n = 1), and renal artery kinking (n = 1). 40 patients were treated by percutaneous transluminal angioplasty (PTA), including 3 balloon catheter dilatation and 37 endovascular stentings, and 14 underwent open surgery. Eventually, 9 patients had graft nephrectomy, resulting in an overall treatment rate of 81.5%. Most vascular complications can be treated satisfactorily with PTA. However, the overall treatment of renal artery rupture, thrombosis, renal artery kinking, and other complications is poor, and the rate of transplanted renal loss is high.
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Affiliation(s)
- Jiangwei Zhang
- Department of Renal Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wujun Xue
- Department of Renal Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Puxun Tian
- Department of Renal Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jin Zheng
- Department of Renal Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Chenguang Ding
- Department of Renal Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yang Li
- Department of Renal Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ying Wang
- Department of Renal Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaoming Ding
- Department of Renal Transplantation, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Sharma A, Ruch B, Alwatari Y, Gupta A, Albuquerque F, Cotterell A, Levy M. Dissection of External Iliac Artery During Pediatric En bloc Kidney Transplant: Successful Rescue and Reimplant. EXP CLIN TRANSPLANT 2021; 20:526-530. [PMID: 34269652 DOI: 10.6002/ect.2021.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
En bloc kidney transplant is a surgical treatment option that increases available donor organs and has excellent graft survival for patients with end-stage renal disease. Herein, we report a case of dissection of the external iliac artery that occurred during en bloc kidney transplant in an adult recipient. The en bloc kidneys were removed, flushed, and then reimplanted after restoring the blood flow to the lower limb. To our knowledge, this is the first case of dissection of the external iliac artery managed successfully during en bloc kidney transplant.
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Affiliation(s)
- Amit Sharma
- From the Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, Virginia, USA
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Vijayvergiya R, Gawalkar A, Kasinadhuni G, Sharma A, Singh S, Lal A. Simultaneous endovascular revascularization of external iliac artery dissection and transplant renal artery stenosis in a recent renal allograft recipient. J Vasc Bras 2021; 20:e20210035. [PMID: 35515085 PMCID: PMC9045529 DOI: 10.1590/1677-5449.210035] [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] [Received: 03/19/2021] [Accepted: 06/29/2021] [Indexed: 11/22/2022] Open
Abstract
Various vascular complications following renal transplantation include renal artery and vein thrombosis, renal artery stenosis, pseudoaneurysm, and iliac artery dissection. Transplant renal artery stenosis (TRAS) is the most common, while iliac artery dissection is the rarest of these various vascular complications. We describe an elderly male, who had both external iliac artery dissection and TRAS at 2 months following renal transplantation. He underwent successful percutaneous endovascular intervention of both complications. The post-intervention course was uneventful, with improvement in graft renal functions and left lower limb perfusion.
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Affiliation(s)
| | - Atit Gawalkar
- Post Graduate Institute of Medical Education & Research, India
| | | | - Ashish Sharma
- Post Graduate Institute of Medical Education & Research, India
| | - Sarbpreet Singh
- Post Graduate Institute of Medical Education & Research, India
| | - Anupam Lal
- Post Graduate Institute of Medical Education & Research, India
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Mokos I, Penezić L, Figl J, Čikić B, Marić M, Bašić Jukić N, Kaštelan Ž. Emergency Ilio-femoral Bypass during Kidney Transplantation due to External Iliac Artery Dissection: Case Report. ACTA MEDICA (HRADEC KRALOVE) 2021; 64:232-234. [PMID: 35285447 DOI: 10.14712/18059694.2022.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Intraoperative iliac artery dissection during kidney transplantation is a rare but serious complication that requires prompt intervention. We present a case of right external iliac artery dissection during deceased donor kidney transplantation. A 57-year-old male patient underwent standard pretransplant evaluation and had no signs of either significant aortoiliac occlusive disease or peripheral arterial occlusive disease. Diabetic nephropathy, arterial hypertension and smoking were the underlying causes of the patient's end-stage renal disease. Transplantation was performed in the standard fashion. The kidney was positioned in the right iliac fossa and the venous end to-side anastomosis was performed first. A significant dissection of the right external iliac artery was found on arteriotomy. Immediate ilio-femoral bypass with a vascular prosthesis was performed. During two years of follow-up the kidney function is stable and there are no signs of lower limb vascular insufficiency.
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Affiliation(s)
- Ivica Mokos
- Department of Urology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Luka Penezić
- Department of Urology, University Hospital Center Zagreb, Zagreb, Croatia.
| | - Josip Figl
- Department of Urology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Bojan Čikić
- Department of Urology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Marjan Marić
- Department of Urology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Nikolina Bašić Jukić
- Department of Nephrology, Arterial Hypertension and Dialysis, University hospital center Zagreb, Zagreb, Croatia
| | - Željko Kaštelan
- Department of Urology, University Hospital Center Zagreb, Zagreb, Croatia
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Xie L, Zeng X, Xia Q, Peng J, Liu F, Chen J, Liu J, Xiao X, Liu J, Li H, Wang Z. Reconstruction of a Transplant Recipient's External Iliac Artery Using Donor's Inferior Vena Cava in Renal Transplantation: 2 Case Reports. Transplant Proc 2020; 53:828-832. [PMID: 33004221 DOI: 10.1016/j.transproceed.2020.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
Iliac atherosclerosis is common in renal transplant recipients. In severe cases, it affects intraoperative renal arterial anastomosis and increases the risk of postanastomosis complications. At present, safe and efficient vascular replacement methods are relatively limited. In the 2 renal transplant cases at our center, described here, the donors' iliac arteries were unavailable. We therefore attempted to replace the recipients' diseased external iliac artery with the donors' inferior vena cava and then performed an end-to-side grafting with the attachment in arterial reconstruction. One patient received a single kidney transplantation, while the other received a dual kidney transplantation. Antiplatelet/anticoagulation drug application was avoided, and both patients were observed for more than 6 months. Stable renal graft function was achieved without any vascular complications. During this study, all procedures were in compliance with the Helsinki Congress and the Declaration of Istanbul. For end-stage renal disease patients with severe iliac atherosclerosis who are waiting for kidney transplantation, a donor's vena cava graft could potentially be a promising replacement option to restore external iliac artery patency and reconstruct renal blood flow, without the necessity of harvesting a recipient's autologous vessels or looking for costly artificial ones.
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Affiliation(s)
- Liangbo Xie
- Department of Urology, Union Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Xianpeng Zeng
- Department of Urology, Union Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Qiuxiang Xia
- Department of Urology, Union Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Jingtao Peng
- Department of Urology, Union Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Fangning Liu
- Department of Urology, Union Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Chen
- Department of Urology, Union Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Jiali Liu
- Department of Urology, Union Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Xiong Xiao
- Department of Urology, Union Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Liu
- Department of Urology, Union Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Li
- Department of Urology, Union Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Zhendi Wang
- Department of Urology, Union Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China.
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External Iliac Artery Dissection During Renal Transplantation: A Case Report and Literature Review. Transplant Proc 2019; 51:538-540. [PMID: 30879584 DOI: 10.1016/j.transproceed.2018.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 12/29/2018] [Indexed: 11/22/2022]
Abstract
Iliac artery dissection in the setting of renal transplant is a rare but potentially catastrophic event that may result in loss of kidney and lower extremity perfusion. We report a right external iliac artery dissection in a 45-year-old man with end-stage renal disease, diabetes, and hypertension who underwent a renal transplant at our institution. An external iliac artery dissection was diagnosed intraoperatively after completion of the arterial anastomosis given the mottled appearance of the kidney and loss of Doppler signal. The dissection was repaired via open endarterectomy, intimal tacking, bovine patching, and re-anastomosis of the kidney to a proximal site on the external iliac artery. To date, 23 cases of transplant-related iliac artery dissection have been described in the literature. Predisposing risk factors include atherosclerosis and hypertension combined with trauma from vascular clamps or suturing. There is a slight male predominance. Only one group utilized an open endarterectomy approach similar to ours, whereas others used synthetic vascular grafts (12 of 23), endovascular stents (4 of 23), donor iliac artery grafts (4 of 23), or saphenous vein grafts (2 of 23). In the absence of long-term outcomes data, the optimal repair mechanism is yet to be established.
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