Guzmán-Rodríguez J Hugo, Plata-Muñoz Juan José, Mancilla Eduardo, Dorantes Joel, Narváez René, Martínez Raúl, Tielve Manuel, Bezaury Paulina, Correa-Rotter Ricardo, Alberú Josefina
Departamento de Trasplantes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán.
Rev Invest Clin. 2003 May-Jun;55(3):297-304.
Transplant renal artery stenosis (TRAS) is a cause of severe post transplant hypertension with a widely variable reported incidence from 1 to 25%. We herein report 3 cases of endoluminal stent placement after percutaneous transluminal angioplasty for treatment of TRAS. Clinical and laboratory findings during their follow-up, suggestive of TRAS included: elevated mean blood pressure, bruit over the graft area(2/3), and increase in serum creatinine (2/3). Doppler sonography, radioisotope renography and arteriography were performed to confirm TRAS diagnosis. The series includes 2 female and 1 male patients; the time elapsed between transplantation and TRAS diagnosis was 25 d, 12 and 65 months, respectively. All grafts were from living related donors. Patients received at least 3 antihypertensive drugs without adequate blood pressure control. Vascular anastomosis was end to end from the renal to the hypogastric artery in two cases, and end to side to the external iliac artery in the other one. After the diagnosis of TRAS, percutaneous transluminal angioplasty with endoluminal metallic Palmaz stent placement was accomplished in the three cases. No complications occurred during or after the procedures. Beneficial clinical results were obtained in all cases documented by a decrease in both: serum creatinine, and mean blood pressure. Average follow-up after stent placement was 13, 19 and 36 months, respectively without evidence of stenosis recurrence
Percutaneous transluminal angioplasty with stent placement is a safe and effective treatment for TRAS associated hypertension and renal dysfunction. Extended follow-up is necessary to evaluate long-term efficacy and safety of this procedure.
移植肾动脉狭窄（TRAS）是导致移植后严重高血压的原因之一，报道的发病率差异很大，为1%至25%。我们在此报告3例经皮腔内血管成形术后行腔内支架置入术治疗TRAS的病例。随访期间提示TRAS的临床和实验室检查结果包括：平均血压升高、移植肾区血管杂音（2/3）和血清肌酐升高（2/3）。进行了多普勒超声、放射性核素肾图和血管造影以确诊TRAS。该系列包括2例女性和1例男性患者；移植与TRAS诊断之间的时间分别为25天、12个月和65个月。所有移植物均来自活体亲属供体。患者至少服用3种降压药但血压控制不佳。2例患者的血管吻合方式为肾动脉与下腹动脉端端吻合，另1例为肾动脉与髂外动脉端侧吻合。诊断TRAS后，3例患者均行经皮腔内血管成形术并置入金属Palmaz腔内支架。手术期间及术后均未发生并发症。所有病例均取得了良好的临床效果，表现为血清肌酐和平均血压均下降。支架置入后的平均随访时间分别为13个月、19个月和36个月，均无狭窄复发迹象。
经皮腔内血管成形术联合支架置入术是治疗TRAS相关高血压和肾功能不全的一种安全有效的方法。需要延长随访时间以评估该手术的长期疗效和安全性。
