title: Percutaneous transluminal angioplasty of transplant renal artery stenosis.
abstract: BACKGROUND
  This study aimed to assess the outcome of percutaneous transluminal angioplasty (PTA) as the primary treatment for transplant renal artery stenosis (TxRAS).
  
  
  METHODS
  A retrospective review of PTA of TxRAS from April 1999 to December 2008 was performed. Twenty-seven patients (17 males (M):10 females (F)) with the mean age of 49.5 years underwent PTA of TxRAS in the review period. Indications for PTA were suboptimal control of hypertension (n=12), impaired renal function (n=6) and both suboptimal control of hypertension and impaired renal function (n=9). All patients had doppler ultrasound scans prior to their PTA. In addition, 5 of these patients had computed tomography angiography (CTA) and another 7 had magnetic resonance angiography (MRA) evaluation. Mean follow-up period was 57.0 months (range, 7 to 108 months).
  
  
  RESULTS
  The stenotic lesions were located proximal to the anastomosis (n=2), at the anastomosis (n=15), and distal to the anastomosis (n=14). Technical success rate was 96.3%. One case was complicated by extensive dissection during PTA, resulting in subsequent graft failure. The overall clinical success rate was 76.9%. Seven out of 26 patients had restenoses (26.9% of cases). These were detected at a mean of 14.3 months post angioplasty (range, 5 to 38 months). All 7 patients underwent a second PTA successfully. Three of these patients required more than 1 repeat PTA.
  
  
  CONCLUSIONS
  PTA is safe and effective in the management of symptomatic TxRAS and should be the primary treatment of choice. Close surveillance for restenosis is required and when diagnosed, re-angioplasty can be performed.
authors.affiliation: Interventional Radiology Centre, Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
authors.forename: Lee Lian
authors.initials: LL
authors.lastname: Chew
authors.forename: Bien Soo
authors.initials: BS
authors.lastname: Tan
authors.forename: Krishna
authors.initials: K
authors.lastname: Kumar
authors.forename: Maung Myint
authors.initials: MM
authors.lastname: Htoo
authors.forename: Kok Seng
authors.initials: KS
authors.lastname: Wong
authors.forename: Christopher W S
authors.initials: CW
authors.lastname: Cheng
authors.forename: Terence K B
authors.initials: TK
authors.lastname: Teo
authors.forename: Farah Gillani
authors.initials: FG
authors.lastname: Irani
authors.forename: Hui Lin
authors.initials: HL
authors.lastname: Choong
authors.forename: Kiang Hiong
authors.initials: KH
authors.lastname: Tay
mesh_terms: D000328:Adult; D017130:Angioplasty; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors