Polytimi Leonardou, Sofia Gioldasi, Paris Pappas
Department of Radiology, Laikon General Hospital of Athens, 17 Ag. Thoma street, 115 27 Athens, Greece.
J Transplant. 2011;2011:219109. doi: 10.1155/2011/219109. Epub 2011 Jul 5.
Purpose. To evaluate the efficacy of percutaneous transluminal angioplasty (PTA) in the management of arterial stenosis located close to the allograft anastomosis (close-TRAS). Materials and Methods. 31 patients with renal transplants were admitted to our institution because of persistent hypertension and impairment of transplant renal function and underwent angiography for vascular investigation. 27 were diagnosed suffering from transplant renal artery stenosis (TRAS), whereas 4 had severe iliac artery stenosis proximal to the transplant anastomosis (Prox-TRAS). 3 cases of TRAS coexisted with segmental renal arterial stenosis, whereas 3 other cases of TRAS were caused by kinking and focal stenosis in the middle of the transplanted renal artery. Results. Angioplasty and stenting were successfully applied to all patients with iliac artery stenosis as well as to those with TRAS and segmental artery stenosis. Two of three patients with kinking were well treated with angioplasty and stenting, whereas one treated only with angioplasty necessitated surgery. No major procedure-related complications appeared, and the result was decrease of the serum creatinine level and of the blood pressure. Conclusions. PTA is the appropriate initial treatment of TRAS and close-TRAS, with low morbidity and mortality rates, achieving improvement of graft function and amelioration of hypertension.
目的。评估经皮腔内血管成形术（PTA）治疗靠近同种异体移植血管吻合口的动脉狭窄（近吻合口移植肾动脉狭窄，close-TRAS）的疗效。材料与方法。31例肾移植患者因持续性高血压和移植肾功能损害入住我院，并接受血管造影以进行血管检查。27例被诊断为移植肾动脉狭窄（TRAS），而4例在移植血管吻合口近端存在严重的髂动脉狭窄（近端TRAS，Prox-TRAS）。3例TRAS合并节段性肾动脉狭窄，另有3例TRAS由移植肾动脉中段扭结和局灶性狭窄引起。结果。血管成形术和支架置入术成功应用于所有髂动脉狭窄患者以及TRAS和节段性动脉狭窄患者。3例扭结患者中有2例通过血管成形术和支架置入术得到良好治疗，而1例仅接受血管成形术治疗的患者需要手术。未出现重大的与手术相关的并发症，结果是血清肌酐水平和血压下降。结论。PTA是TRAS和close-TRAS的合适初始治疗方法，发病率和死亡率低，可改善移植肾功能并缓解高血压。
