Péret M, Lhommet P, Villemain F, Abraham P, Picquet J, Enon B
Service de chirurgie vasculaire et thoracique, CHU d'Angers, 4, rue Larrey, 49033 Angers, France.
J Mal Vasc. 2013 Feb;38(1):52-7. doi: 10.1016/j.jmv.2012.11.006. Epub 2013 Jan 18.
Renal transplant patients are high cardiovascular risk patients. Regular ultrasound surveillance of the renal transplant artery and the iliac artery upstream from the anastomosis is required to detect potential arterial stenosis. The purpose of this article was to illustrate the hemodynamic impact of exercise in such patients and the screening efficiency of Doppler ultrasound stress testing.
Two renal transplant patients were hospitalized in our center for impaired renal function, worsening hypertension, and intermittent claudication. This association of peripheral vascular disease and renal dysfunction led us to perform a Doppler ultrasound stress test to search for vascular stenosis upstream from the graft. Hemodynamic fluctuations in the ipsilateral leg were recorded during flexion-extension exercises.
Iliac artery lesions were found in both patients: the Doppler examination showed decreased systolic velocity in the graft artery during exercise, compatible with iliac steal syndrome. Surgical treatment was performed in both patients. After surgery, the control Doppler ultrasound stress test showed that systolic flow did not decline in the graft vessels during exercise. Renal function stabilized in one patient and improved in the other; claudication disappeared after surgery.
Doppler ultrasound stress testing can be a valuable tool for detecting exercise-induced renal graft ischemia in transplant patients. Its screening performance should be determined in a larger population before routine use.
肾移植患者是心血管高危人群。需要定期对肾移植动脉及吻合口上游的髂动脉进行超声监测，以检测潜在的动脉狭窄。本文旨在阐述运动对此类患者的血流动力学影响以及多普勒超声负荷试验的筛查效率。
两名肾移植患者因肾功能受损、高血压加重和间歇性跛行入住我院。外周血管疾病与肾功能不全的这种关联促使我们进行多普勒超声负荷试验，以寻找移植肾上游的血管狭窄。在屈伸运动过程中记录同侧下肢的血流动力学波动情况。
两名患者均发现髂动脉病变：多普勒检查显示运动期间移植肾动脉收缩期速度降低，符合髂动脉盗血综合征。两名患者均接受了手术治疗。术后，对照多普勒超声负荷试验显示运动期间移植血管的收缩期血流未下降。一名患者的肾功能稳定，另一名患者的肾功能改善；术后跛行消失。
多普勒超声负荷试验可能是检测移植患者运动诱发的肾移植缺血的一项有价值的工具。在常规使用之前，应在更大规模的人群中确定其筛查性能。
