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

Abstract

Background: 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. Material and Methods: 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 rup- ture 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 endo- prostheses (Hemobahn-Gore) release whereas in the other a balloon-expandable covered stent (Advanta V12 Boston Sci- entific) was used. Results: After treatment clinical, ultrasonographic and Doppler parameters showed a complete functional recovery of ileo- femoral 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. Conclusion: 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.