title: Endovascular Approach to Transplant Renal Artery Stenosis.
abstract: BACKGROUND
  The endovascular approach has shown high initial technical success rates, good patency rates, and minimal complications in treating transplant renal artery stenosis (TRAS). The objective of this study was to describe our experience with an endovascular approach to TRAS.
  
  
  METHODS
  We performed a retrospective single-institutional review of all kidney transplant procedures performed at our institution from September 2009 to September 2014. All consecutive cases of TRAS were included.
  
  
  RESULTS
  From a total of 183 kidney transplantations, 16 patients had TRAS. Mean time from transplantation to TRAS diagnosis was 201.8 days. Stenoses or hemodynamic significant kinkings were located at the anastomosis (7), proximal (5) and middle (4) portions of the transplant artery. All patients were treated with angioplasty and primary balloon-expanding stenting. Early technical success was 93.75% and local complication rate was 12.5%. No deaths occurred. Mean serum creatinine level dropped from 3.87 mg/dL to 2.91 mg/dL after 24 hours; 1.85 mg/dL after one month; and 1.67 mg/dL after three months (P<0.05). Mean estimated glomerular filtration rate increased from 31.60 mL/min to 39.53 mL/min after 24 hours; 50.92 mL/min after one month; and 55.05 mL/min after three months (P<0.05). Doppler ultrasound criteria normalized after the procedure. Number of classes of antihypertensive drugs was not different before and after the procedure (P=0.38). Mean follow-up time was 9.75 months. One patient had a restenosis and required surgical intervention to restore graft function.
  
  
  CONCLUSIONS
  The endovascular approach to TRAS with primary balloon-expanding stenting was safe and had a high rate of technical success. It was effective for restore and maintain the renal function in transplant kidney grafts with a low rate of restenosis.
authors.affiliation: Department of Surgery and Anatomy, Division of Vascular and Endovascular Surgery, University of São Paulo, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, SP, Brazil.
authors.forename: André Felipe Farias
authors.initials: AF
authors.lastname: Braga
authors.affiliation: Department of Surgery and Anatomy, Division of Vascular and Endovascular Surgery, University of São Paulo, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, SP, Brazil.
authors.forename: Rafel Cespedes
authors.initials: RC
authors.lastname: Catto
authors.affiliation: Department of Surgery and Anatomy, Division of Vascular and Endovascular Surgery, University of São Paulo, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, SP, Brazil.
authors.forename: Marcelo Bellini
authors.initials: MB
authors.lastname: Dalio
authors.affiliation: Department of Surgery and Anatomy, Division of Vascular and Endovascular Surgery, University of São Paulo, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil.
authors.forename: Emanuel Junio Ramos
authors.initials: EJ
authors.lastname: Tenório
authors.affiliation: Department of Surgery and Anatomy, Division of Vascular and Endovascular Surgery, University of São Paulo, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil.
authors.forename: Maurício Serra
authors.initials: MS
authors.lastname: Ribeiro
authors.affiliation: Department of Surgery and Anatomy, Division of Vascular and Endovascular Surgery, University of São Paulo, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, SP, Brazil.
authors.forename: Carlos Eli
authors.initials: CE
authors.lastname: Piccinato
authors.affiliation: Department of Surgery and Anatomy, Division of Vascular and Endovascular Surgery, University of São Paulo, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, SP, Brazil.
authors.forename: Edwaldo Edner
authors.initials: EE
authors.lastname: Joviliano
mesh_terms: D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000379:methods*; D001938:Brazil; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology*
chemical_list: D003404:Creatinine