Clinical Outcomes Of Intravascular Ultrasound-confirmed Symptomatic Transplant Renal Artery Stenosis After Endovascular Treatment
Ronak Patel, MD, Josue Gutierrez, MD, Mohsen Bannazadeh, MD, Nicholas Sikalas, MD, Frank Darras, MD, Angela Kokkosis, MD, Nicos Labropoulos, PhD.
Stony Brook University Hospital, Stony Brook, NY, USA.
OBJECTIVES: Transplant renal artery stenosis (TRAS) is a known cause of clinically significant renal dysfunction in renal transplant patients. Current screening is performed with duplex ultrasonography and typically confirmed with digital subtraction angiography (DSA), however focal stenoses are often missed by DSA. The goal of this study was to assess the short-term clinical outcomes of endovascular intervention for TRAS confirmed by intravascular ultrasound (IVUS) assessment.
METHODS: We performed a retrospective review of all transplant angiograms from January 2017 to June 2021. 43 transplant patients with clinical signs of renal dysfunction and duplex ultrasound findings suspicious for TRAS underwent DSA and IVUS for definitive evaluation with intention to treat. 22 patients with TRAS confirmed by IVUS were treated with angioplasty (n=2) and stenting (n=20). Technical success, vessel patency, and pre- and post-treatment serum creatinine, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were analyzed.
RESULTS: Technical success was achieved in all patients. Within three months follow-up, post-treatment serum creatinine decreased by 1.06 mg/dL (95%CI -1.63, -0.48 mg/dL; P < 0.001) and post-treatment SBP & DBP decreased by 15.03 mmHg (95%CI -21.60, -8.46 mmHg; P < 0.001) and 5.94 mmHg (95% CI-8.90, -2.97 mmHg; P < 0.001) respectively. IVUS identified 8 patients with stenosis greater than 50% that were not identified by performing vessel measurements of transplant artery angiograms.
CONCLUSIONS: Optimal imaging of TRAS was achieved using IVUS, resulting in the identification and treatment of patients that would have been misdiagnosed using DSA alone. Endovascular treatment of TRAS detected by IVUS provides objectively improved renal function and decreased blood pressure in early follow-up. Our findings warrant larger studies with longer follow-up to determine durability of the interventions and further optimize the management of such patients.
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