Adani Gian Luigi, Como Giuseppe, Bonato Filippo, Girometti Rossano, Baccarani Umberto, Vit Alessandro, Righi Elda, Tulissi Patrizia, Sponza Massimo, Risaliti Andrea
Kidney & Liver Transplantation, Department of Medicine, University of Udine, Via Colugna 50, 33100 Udine, Italy.
Institute of Radiology, Department of Medicine, University of Udine, Via Colugna 50, 33100 Udine, Italy.
Radiol Case Rep. 2018 Jul 5;13(4):890-894. doi: 10.1016/j.radcr.2018.06.003. eCollection 2018 Aug.
Transplant renal artery stenosis (TRAS) is a vascular complication occurring during the first 2 years after kidney transplantation, with an incidence and a prevalence ranging from 1% to 23%, and from 1.5% to 4%, respectively. Detection of TRAS is the key, since most stenoses may progress to renal graft loss, however it may be difficult to detect due to its nonspecific clinical manifestations. Although Doppler ultrasound has become a primary imaging technique, digital subtraction angiography (DSA) remains the gold standard for diagnosing TRAS. We present a case of delayed graft function following kidney transplantation complicated by a lateral by-pass with prosthesis upstream and downstream of renal anastomosis, TRAS criteria were unclear using Doppler ultrasound, contrast-enhanced computed tomography-scan, and DSA. Only contrast-enhanced ultrasound (CE-US), observing a delayed and pulsating contest impregnation of renal parenchyma, supported the hypothesis of TRAS that was confirmed by the measurement of trans-anastomosis pressure gradient during DSA.
移植肾动脉狭窄（TRAS）是肾移植后2年内发生的一种血管并发症，其发病率和患病率分别为1%至23%和1.5%至4%。TRAS的检测是关键，因为大多数狭窄可能进展为移植肾丢失，然而由于其临床表现不具特异性，可能难以检测。尽管多普勒超声已成为主要的成像技术，但数字减影血管造影（DSA）仍是诊断TRAS的金标准。我们报告一例肾移植后移植肾功能延迟的病例，该病例在肾吻合口上游和下游有带假体的侧支旁路，使用多普勒超声、对比增强计算机断层扫描和DSA均无法明确TRAS标准。只有对比增强超声（CE-US）观察到肾实质有延迟且搏动性的造影剂灌注，支持了TRAS的假设，这一假设在DSA期间通过测量跨吻合口压力梯度得到证实。
