title: Combined Percutaneous Transrenal and Transfemoral Endovascular Recanalization and Angioplastic Reconstruction of a Disrupted Transplant Renal Artery Stent: A Novel Salvage Technique.
abstract: Renal artery stenosis is the most common vascular complication following renal transplantation. Percutaneous endovascular transluminal angioplasty with stenting is the treatment of choice for clinically significant renal artery stenosis. The authors present a case describing a novel combined transrenal parenchyma and transfemoral approach to repairing a disrupted transplant renal artery stent. The patient's allograft renal artery stenosis was initially managed via the standard percutaneous approach, but during follow-up the stent became disrupted and crushed, causing partial occlusion of the renal artery. This was manifested by persistently elevated serum creatinine values, lower extremity edema, and four-medication hypertension. After a failed traditional percutaneous transfemoral attempt, the authors were able to successfully access the renal arterial system via a combined transrenal and transfemoral approach, using an upper-pole artery through the renal parenchyma. This transrenal approach used a 3 Fr system, allowing the authors to get a wire across the stent, which they were previously unable to do. With wire access, they performed a balloon angioplastic reconstruction to restore the stent's patency, resulting in a reduction in serum creatinine, lower extremity edema, and blood pressure. This technique avoided a potentially difficult reoperative repair without immediate complication and provides a method for vascular access to the renal arterial system in select patients.
authors.affiliation: Division of General Surgery, Department of Surgery, Columbia University Medical Center, New York, NY.
authors.forename: D J
authors.identifier: 0000-0001-6008-5868
authors.initials: DJ
authors.lastname: Carpenter
authors.affiliation: Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, NY.|The Columbia University Renal Epidemiology (CURE) Group, New York, NY.
authors.forename: S
authors.initials: S
authors.lastname: Mohan
authors.affiliation: Division of Transplantation, Department of Surgery, Columbia University Medical Center, New York, NY.
authors.forename: L E
authors.initials: LE
authors.lastname: Ratner
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Columbia University Medical Center, New York, NY.
authors.forename: P
authors.initials: P
authors.lastname: Schlossberg
mesh_terms: D017130:Angioplasty / Q000379:methods*; D006801:Humans; D007668:Kidney / Q000098:blood supply*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000601:surgery*; D012078:Renal Artery Obstruction / Q000209:etiology / Q000628:therapy*; D016879:Salvage Therapy; D015607:Stents
keywords: clinical decision-making; clinical research/practice; diagnostic techniques and imaging; endovascular procedures/stenting; kidney transplantation/nephrology; organ transplantation in general; surgical technique