Alternative management of early anastomotic transplant renal artery stenosis: the prosthetic enlargement patch.
BACKGROUND
We describe a surgical technique to manage anastomotic transplant renal artery stenosis (TRAS). TRAS is one of the most common vascular complications and is usually treated by percutaneous angioplasty (PA) with good results. To our knowledge, management of early (less than a month) anastomotic TRAS with a prosthetic enlargement patch has never been described in the literature.


METHODS
Two men (ages 67 and 57 years) underwent deceased and living donor renal transplantation, respectively. At 1 week post-transplantation, they each presented with a tight arterial anastomotic stenosis. Because percutaneous angioplasty soon after renal transplantation has a risk of acute bleeding, it was decided that a surgical intervention should be used. Follow-up at 4 months showed that surgical addition of the prosthetic enlargement patch normalized arterial pressure and improved kidney function as documented by decreased serum creatinine levels. No surgical complications were associated with these cases.


CONCLUSIONS
This technique provided significant benefits in terms of technical simplicity and safety. When a new anastomosis seems to be difficult to perform, this approach represents a good alternative if percutaneous angioplasty is not available or is medically unadvisable.
Department of Urology and Transplantation, CHU Côte de Nacre, Caen, France.
Arnaud
A
Doerfler
Department of Urology and Transplantation, CHU Côte de Nacre, Caen, France.
Adrien
A
Lee-Bion
Department of Urology and Transplantation, CHU Côte de Nacre, Caen, France.
Xavier
X
Tillou
D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome