XXXX proximal to a kidney transplant: clinical findings, duplex-sonographic criteria, treatment, and outcome.

@entity1 @entity8 @entity455 @entity101 @entity2791 @entity177 @entity865 @entity23067 @entity810 @entity1011 @entity813 @entity551
BACKGROUND: Stenosis of the @entity8 ( @entity23067 -TRAS) is an uncommon cause of @entity813 and @entity101 . We assessed the role of duplex sonography (DS) in regard to clinical and angiographic findings and followed the @entity1 after percutaneous transluminal angioplasty ( @entity865 ), @entity865 stenting (PTAS), or surgery. METHODS: From January 1988 to August 2001, 97 of 1,064 kidney recipients underwent angiography for clinical or Doppler-sonographic suspicion of vascular problems. Kidney function, blood pressure, medication, and DS findings after renal transplantation (RTx) at the time of diagnosis of @entity23067 -TRAS and after treatment were evaluated. RESULTS: @entity23067 -TRAS was diagnosed in 16 @entity1 (1.5%) (49.6+/-6.9 years). Four @entity1 demonstrated early presentation of @entity23067 -TRAS 1 to 7 days after RTx (group A), leading to @entity810 but without @entity101 . In all @entity1 , DS revealed pulsus parvus et tardus, low pulsatility index (PI) (<1.0), and a pathologic flow profile in the iliac artery proximal and distal to the graft. After treatment (surgery in two @entity1 , @entity865 in one @entity1 , PTAS in one @entity1 ), all @entity1 developed @entity177 ( @entity1011 1.7+/-0.9 mg/dL). PI increased from 0.9+/-0.1 to 1.2+/-0.1 (P=0.04), and flow profile within the iliac artery distal to the graft normalized. Late presentation (3-209 months after RTx) of @entity23067 -TRAS was observed in 12 @entity1 (group B), causing an increase of @entity1011 in 11 @entity1 (two @entity1 receiving dialysis treatments), @entity551 (141+/-15 and 80.7+/-7 to 160+/-18 and 85+/-7 mm Hg, P=0.009), and an increase in antihypertensive drugs (2.1+/-1.1 and 4.3+/-1, P=0.003) in all @entity1 . The PI was decreased when compared with values early after RTx (1.6+/-0.4 to 1.2+/-0.3, P=0.007), and flow profile in the iliac artery was pathologic. All @entity1 except one were managed by surgery (n=6), @entity865 (n=1), or PTAS (n=4). @entity1011 (2.7+/-1.4 to 1.8+/-0.4 mg/dL, P=0.02) and blood pressure (160+/-18/85+/-7 mm Hg to 138+/-7/82+/-9, P=0.018) improved. Antihypertensive drugs were reduced to 2.8+/-0.8 (P=0.01). PI increased from 1.2+/-0.3 to 1.9+/-0.5 (P=0.01). Flow profile within the iliac artery distal to the graft anastomosis normalized. Kidney function, blood pressure, and PI remained unchanged during follow-up (82+/-69.9 months) in both groups. CONCLUSIONS: @entity23067 -TRAS is rare. Because clinical symptoms are similar to those of transplant @entity2791 , DS is a valuable tool for diagnosis and follow-up for this type of @entity455 . Selective treatment with @entity865 , PTAS, or surgery improves kidney function and @entity101 .
