Helical computed tomography angiography is the most efficient test to assess vascular calcifications in the iliac arterial sector in renal transplant candidates.
The increased scope of renal transplant indications has lead to a larger number of recipients with vascular problems due to arterial calcifications in the iliac region. Compared to magnetic resonance and conventional arteriography, helical computed tomography angiography (HCTA) accurately depicts arterial diseases, including the location and extent of arterial calcification. The objective of this study was to assess the value of HCTA with maximum-intensity-projection (MIP) reconstruction to evaluate iliac arterial calcifications and stenosis among candidates for renal transplantation.


METHODS
From December 1997 to March 2002, 114 HCTA scans with MIP reconstruction were performed in candidates for renal transplantation. Included patients fulfilled some of the following conditions: (a) older than 55 years, (b) diabetic, (c) second transplants, and (d) obvious vascular calcifications on plain abdominal x-ray.


RESULTS
Among the 114 patients, 33 (29%) were excluded for transplantation due to universal calcification of the iliac arterial sector, and 81 (71%) were included on the waiting list due to the presence of calcium-free areas for the vascular anastomosis. Transplantation, which was attempted in 28 of the 81 patients, was successful in 25 using the area programmed after HCTA analysis. The transplants failed in three cases because no calcium-free area could be found upon surgical examination.


CONCLUSIONS
HCTA with MIP reconstruction makes it possible to draw an exact map of the arterial calcifications of the iliac arterial sector, allowing better recipient selection and accurate planning for the vascular anastomosis and placement of the renal graft.
Andres
A
A
Nephrology Department, Hospital 12 de Octubre, Madrid, Spain.
Revilla
Y
Y
Ramos
A
A
Gonzalez
E
E
Vereda
M S
MS
Praga
M
M
Morales
E
E
Morales
J M
JM
Diaz
R
R
Cruceyra
G
G
Aguirre
F
F
Leiva
O
O
Gragera
F
F
D000792:Angiography / Q000379:methods*; D002114:Calcinosis / Q000000981:diagnostic imaging*; D003928:Diabetic Nephropathies / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D007091:Image Processing, Computer-Assisted; D016030:Kidney Transplantation / Q000009:adverse effects / Q000502:physiology*; D008875:Middle Aged; D018579:Patient Selection; D015203:Reproducibility of Results; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*