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Interventional radiology-guided percutaneous nephrostomy and nephroureteral stent placement showing urine leak at the lower pole of the kidney.
Context in source publication
Context 1
... confirmed that the previously known small area of parenchymal ischemia had now resulted in complete necrosis leading to a urine leak. Foley catheter was placed initially for distal urinary decompression followed by interventional radiology-guided percutaneous nephrostomy and nephroureteral stent to divert urine drainage (Figure 8). Perinephric fluid collection (urine), which was compressing the kidney, was treated using computed tomography-guided catheter placement (Figure 9). ...
Citations
... Vascular complications post-renal transplantation are commonly reported, ranging from as low as 3% to 30% [1]. Based on the variable definitions of vascular complications and the imaging techniques used for their diagnosis, there is a wide range in the literature [2]. ...
We report the case of a 51-year-old gentleman who underwent living renal transplantation in Pakistan for end-stage renal disease one and a half years ago. He presented to our hospital with renal artery stenosis and an extra-renal pseudoaneurysm at the anastomotic site of the transplanted kidney. This can cause graft dysfunction and hypertension due to impairment of arterial perfusion in the transplanted kidney. Treatment with percutaneous transluminal angioplasty and covered stenting of the pseudoaneurysm and stenosis improved kidney function and hypertension.
Renal transplantation is the preferred treatment for end-stage renal disease, with vascular complications being a significant cause of graft dysfunction. Although many surgical methods are used to ensure the most effective possible vascular anastomosis, autologous saphenous vein grafting remains a less explored approach to renal transplantation. Chronic kidney disease often presents with complications related to impaired renal perfusion, necessitating interventions to improve blood flow to the kidneys. Herein, we present a case report detailing the utilization of autologous saphenous grafting to establish an anastomosis between the renal vein and external iliac vein in a patient with сhronic kidney disease with maintenance hemodialysis twice a week. This case report indicates the potential and prospective advantages of using autologous saphenous grafting for intricate renal vein reconstructions in patients with chronic kidney disease.
Background
Transplant renal artery dissection (TRAD) is a rare and serious event that can cause allograft dysfunction and eventually graft loss. Most cases are managed by operative repair. We report a case of TRAD in the early postoperative period, which was successfully managed with intravascular ultrasound-assisted endovascular intervention.
Case presentation
A 38-year-old man underwent HLA-compatible living kidney transplantation. The allograft had one renal artery and vein, which were anastomosed to the internal iliac artery and external iliac vein, respectively. Doppler ultrasonography performed a day after the operation showed an increase in systolic blood velocity, with no observed urine output and raising a suspicion of arterial anastomotic stenosis. Angiography showed a donor renal artery dissection distal to the moderately stenosed anastomosis site with calcified atherosclerotic plaque confirmed by IVUS. The transplant renal artery lesion was intervened with a stent. After the intervention, Doppler US revealed that the blood flow of the renal artery was adequate without an increase in the systolic blood velocity. Urine output gradually returned after 3 weeks, and serum creatinine level was normalized after 2 months.
Conclusions
Transplant recipients commonly have atherosclerosis and hypertension, which are risk factors for arterial dissection. Our case showed that endovascular intervention can replace surgery to repair very early vascular complications such as dissection and help patients avoid high-risk operations. Early diagnosis and IVUS-assisted intervention with experienced interventionists can save allograft dysfunction.
