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Restoration of Failed Renal Graft Function After Successful Angioplasty of Pressure-Resistant Renal Artery Stenosis Using a Cutting Balloon: A Case Report

  • J. H. PeregrinEmail author
  • M. Bürgelová
Case Report

Abstract

This study is the report of a 37-year-old male with a transplanted kidney from a 3.5-year-old donor: the graft had two arteries transplanted with an aortic patch to an external iliac artery. Four months after transplantation, the graft function deteriorated, together with the development of hypertension. Stenosis of both graft arteries was detected and the patient was referred for angioplasty. The angiographic result was suboptimal, nevertheless, the graft function improved and was more or less stable (serum creatinine, 160–200 μmol/l) for 4 years, along with persistently difficult-to-control hypertension. Five years after transplantation, the graft function deteriorated again and severe graft artery restenosis was detected. The restenosis did not respond to dilatation, graft function failed, hypertension decompensated, and left ventricular failure developed. The patient required dialysis. A cutting balloon angioplasty opened the artery, and kidney function was restored after a few days: the serum creatinine level dropped to 140–160 μmol/l, and the glomerular filtration rate (creatinine clearance) to 0.65 ml/min/1.73 m². The graft function has now been stable for more than 2 years, however, the hypertension is still difficult to control.

Keywords

Kidney transplantation Graft failure Percutaneous transluminal angioplasty Cutting balloon 

Notes

Acknowledgment

Financial support was provided by the Institute for Clinical and Experimental Medicine (Grant No. MZO 00023001).

References

  1. 1.
    Chandrasoma P, Aberle AM (1986) Anastomotic line renal artery stenosis after transplantation. J Urol 135:1159–1162PubMedGoogle Scholar
  2. 2.
    Lacombe M (1988) Renal artery stenosis after renal transplantation. Ann Vasc Surg 2:155–160PubMedCrossRefGoogle Scholar
  3. 3.
    Morris PJ, Yadav RV, Kincaid-Smith P et al (1971) Renal artery stenosis in renal transplantation. Med J Aust 1:1255–1257PubMedGoogle Scholar
  4. 4.
    Munda R, Alexander JW, Miller S, First MR, Fidler J (1977) Renal allograft artery stenosis. Am J Surg 134:400–403PubMedCrossRefGoogle Scholar
  5. 5.
    Roberts JP, Ascher NL, Fryd DS et al (1989) Transplant renal artery stenosis. Transplantation 48:580–583PubMedGoogle Scholar
  6. 6.
    Mell MW, Alfrey EJ, Rubin GD, Scandling JD, Jeffrey RB, Dafoe DC (1994) Use of spiral computed tomography in the diagnosis of transplant renal artery stenosis. Transplantation 57:746–748PubMedCrossRefGoogle Scholar
  7. 7.
    Luk SH, Chan JH, Kwan TH, Tsui WC, Cheung YK, Yuen MK (1999) Breath-hold 3D gadolinium-enhanced subtraction MRA in the detection of transplant renal artery stenosis. Clin Radiol 54:651–654PubMedCrossRefGoogle Scholar
  8. 8.
    Bruno S, Remuzzi G, Ruggenenti P (2004) Transplant renal artery stenosis. J Am Soc Nephrol 15:134–141PubMedCrossRefGoogle Scholar
  9. 9.
    Audard V, Matignon M, Hemery F et al (2006) Risk factors and long-term outcome of transplant renal artery stenosis in adult recipients after treatment by percutaneous transluminal angioplasty. Am J Transplant 6:95–99PubMedCrossRefGoogle Scholar
  10. 10.
    Fervenza FC, Lafayette RA, Alfrey EJ, Petersen J (1998) Renal artery stenosis in kidney transplantation. Am J Kidney Dis 31:142–148PubMedCrossRefGoogle Scholar
  11. 11.
    Marques M, Prats D, Sánchez-Fructuoso A et al (2001) Incidence of renal artery stenosis in pediatric en bloc and adult single kidney transplants. Transplantation 71:164–166PubMedCrossRefGoogle Scholar
  12. 12.
    Stanley P, Malekzadeh M, Diament MJ (1987) Posttransplant renal artery stenosis: angiographic study in 32 children. Am J Roentgenol 148:487–490Google Scholar
  13. 13.
    Fauchald P, Vatne K, Paulsen D et al (1992) Long-term clinical results of percutaneous transluminal angioplasty in transplant renal artery stenosis. Nephrol Dial Transplant 7:256–259PubMedGoogle Scholar
  14. 14.
    Wong W, Fynn SP, Higgins RM et al (1996) Transplant renal artery stenosis in 77 patients—Does it have an immunological cause? Transplantation 61:215–219PubMedCrossRefGoogle Scholar
  15. 15.
    Pouria S, State OI, Wong W, Hendry BM (1998) CMV infection is associated with transplant renal artery stenosis. Q J Med 91:185–189Google Scholar
  16. 16.
    Humar A, Uknis M, Papalois V, Gillingham K, Matas A (2000) Is there an association between cytomegalovirus and renal artery stenosis in kidney transplant recipients? Transplantation 69:S386 (abstr)Google Scholar
  17. 17.
    Becker BN, Odorico JS, Becker YT et al (1999) Peripheral vascular disease and renal transplant artery stenosis: a reappraisal of transplant renovascular disease. Clin Transplant 13:349–355PubMedCrossRefGoogle Scholar
  18. 18.
    Peregrin JH, Stříbrná J, Lácha J, Skibová J (2008) Long-term follow-up of renal transplant patients with renal artery stenosis treated by percutaneous angioplasty. Eur J Radiol 66:512–518PubMedCrossRefGoogle Scholar
  19. 19.
    Sankari BR, Geisinger M, Zelch M, Brouhard B, Cunningham R, Novick AC (1996) Post-transplant renal artery stenosis: impact of therapy on long-term kidney function and blood pressure control. J Urol 155:1860–1864PubMedCrossRefGoogle Scholar
  20. 20.
    Patel NH, Jindal RM, Wilkin T et al (2001) Renal arterial stenosis in renal allografts: retrospective study of predisposing factors and outcome after percutaneous transluminal angioplasty. Radiology 219:663–667PubMedGoogle Scholar
  21. 21.
    Matalon TA, Thompson MJ, Patel SK, Brunner MC, Merkel FK, Jensik SC (1992) Percutaneous transluminal angioplasty for transplant renal artery stenosis. J Vasc Interv Radiol 3:55–58PubMedCrossRefGoogle Scholar
  22. 22.
    Greenstein SM, Verstandig A, McLean GK et al (1987) Percutaneous transluminal angioplasty: the procedure of choice in the hypertensive renal allograft recipient with renal artery stenosis. Transplantation 43:29–32PubMedCrossRefGoogle Scholar
  23. 23.
    Grossman RA, Dafoe DC, Shoenfeld RB et al (1982) Percutaneous transluminal angioplasty treatment of renal transplant artery stenosis. Transplantation 34:339–343PubMedCrossRefGoogle Scholar
  24. 24.
    Benoit G, Hiesse C, Icard P et al (1987) Treatment of renal artery stenosis after renal transplantation. Transplant Proc 19:3600–3601PubMedGoogle Scholar
  25. 25.
    Rundback JH, Sacks D, Kent KC et al (2003) Guidelines for the reporting of renal revascularization in clinical trials. J Vasc Intervent Radiol 14:477–492Google Scholar
  26. 26.
    Gray DW (1994) Graft renal artery stenosis in the transplanted kidney. Transplant Rev 8:15–21CrossRefGoogle Scholar
  27. 27.
    Murumatsu T, Tsukahara R, Ho M et al (1999) Efficacy of cutting balloon angioplasty for lesions at the ostium of the coronary arteries. J Invas Cardiol 11:201–206Google Scholar
  28. 28.
    Kondo T, Kawaguchi K, Awaji Y et al (1997) Immediate and chronic results of cutting balloon angioplasty: a matched comparison with conventional angioplasty. Clin Cardiol 20:459–463PubMedCrossRefGoogle Scholar
  29. 29.
    Adamian M, Marsico F, Di Mario C et al (1999) Cutting balloon: a matched comparison with conventional angioplasty and atherectomy. Circulation 100:1–305Google Scholar
  30. 30.
    Song HH, Kim KT, Chung SK, Kim YO, Yoon SA (2004) Cutting balloon angioplasty for resistant venous stenoses of Brescia-Cimino fistulas. J Vasc Interv Radiol 15:1963–1967Google Scholar
  31. 31.
    Bittl JA, Feldman RL (2003) Cutting balloon angioplasty for undilatable venous stenoses causing dialysis graft failure. Catheter Cardiovasc Interv 58:524–526PubMedCrossRefGoogle Scholar
  32. 32.
    Peregrin JH, Rocek M (2007) Results of a peripheral cutting balloon prospective multicenter European registry in hemodialysis vascular access. CardioVasc Interv Radiol 30:212–215CrossRefGoogle Scholar
  33. 33.
    Sreenarasimhaiah VP, Margassery SK, Martin KJ, Bander SJ (2004) Cutting balloon angioplasty for resistant venous anastomotic stenoses. Semin Dialysis 17:523–527CrossRefGoogle Scholar
  34. 34.
    Zeller T, Sixt S, Rastan A, Schwarzwalder U, Muller C, Frank U, Burgelin K, Schwarz T, Hauswald K, Brantner R, Noory E, Neumann FJ (2007) Treatment of reoccurring instent restenosis following reintervention after stent-supported renal artery angioplasty. Catheter Cardiovasc Interv 70:296–300PubMedCrossRefGoogle Scholar
  35. 35.
    Towbin RB, Pelchovitz DJ, Baskin KM, Cahill AM, Roebuck DJ, McClaren CA (2007) Cutting balloon angioplasty in children with resistant renal artery stenosis. J Vasc Interv Radiol 18:663–669PubMedCrossRefGoogle Scholar
  36. 36.
    Tanaka R, Higashi M, Naito H (2007) Angioplasty for non-arteriosclerotic renal artery stenosis: the efficacy of cutting balloon angioplasty versus conventional angioplasty. CardioVasc Interv Radiol 30:601–606CrossRefGoogle Scholar
  37. 37.
    Caramella T, Lahoche A, Negaiwi Z, Lions C, Willoteaux S, Boivin V, Gaxotte V, Beregi JP (2005) False aneurysm formation following cutting balloon angioplasty in the renal artery of a child. J Endovasc Ther 12:746–749PubMedCrossRefGoogle Scholar
  38. 38.
    Lupattelli T, Nano G, Inglese L (2005) Regarding “Cutting balloon angioplasty of renal fibromuscular dysplasia: a word of caution.” J Vasc Surg 42:1038–1039, author reply 1039–1040Google Scholar
  39. 39.
    Cejna M (2005) Cutting balloon: review on principles and background of use in peripheral arteries. CardioVasc Interv Radiol 28:400–408CrossRefGoogle Scholar
  40. 40.
    Oguzkurt L, Tercan F, Gulcan O, Turkoz R (2005) Rupture of the renal artery after cutting balloon angioplasty in a young woman with fibromuscular dysplasia. CardioVasc Interv Radiol 28:360–363CrossRefGoogle Scholar
  41. 41.
    Weinberg JM (1995) Pathogenetic mechanisms of ischemic acute renal failure. In: Jacobson HR, Striker GE, Klahr S (eds) The principles and practice of nephrology. 2nd edn. Mosby-Year Book, St. Louis, MO, pp 544–555Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of Diagnostic and Interventional RadiologyInstitute for Clinical and Experimental MedicinePragueCzech Republic
  2. 2.ZRIR, IKEMPragueCzech Republic
  3. 3.Department of NephrologyInstitute for Clinical and Experimental MedicinePragueCzech Republic

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