Percutaneous Endovascular Repair and Savage of Vascular Stream After Spontaneous and/or Iatrogenic Complications of Kidney Transplantation

ABSTRACT

Vascular complications are uncommon (1-3%) in kidney transplantation. Recipient morbidities may result in loss of the allograft. Early and middle-term vascular complications include external iliac artery iatrogenic or spontaneous lesions and drainage vein thrombosis. Percutaneous transluminal angioplasty (PTA) is proposed as a valid, less invasive and alternative treatment to surgical repair.

Three patients, in the last two years, referred to our Institute: one affected by dissection secondary to the site clamp and suture stenosis of the external iliac artery, one spontaneous pseudoaneurysm with uncontained rupture of the same artery and another with pseudoaneurysm at the site of previous transplantation. All patients were treated by endovascular PTA approach. Patients with pseudo-aneurysm were treated by self-expandable stent-graft PTFE endoprostheses (Hemobahn-Gore) release whereas in the other a balloon-expandable covered stent (Advanta V12 Boston Scientific) was used.

After treatment clinical, ultrasonographic and Doppler parameters showed a complete functional recovery of ileofemoral axis as well renal function. All patients were discharged 5 days after the procedure. At an average follow-up of 12 months, by angio-CT scan, no recurrence of stenoses or aneurysms were found.

PTA followed by stent placement is safe, effective and less invasive than surgical repair. Short and middle-term follow-up showed the benefit of the procedure, moreover the hospital stay is dramatically reduced. All renal allograft recipients, with vascular complications, should undergo to PTA procedure as a first option.