Safety And Efficacy Of Drug-eluting Stents For Treatment Of Transplant Renal Artery Stenosis
Author Type(s)
Faculty
Document Type
Abstract
Publication Date
2022
DOI
10.1016/j.avsg.2021.12.060
Journal Title
Annals of Vascular Surgery
Department
Surgery
Abstract
INTRODUCTION AND OBJECTIVES: There is a paucity of clinical data on use of drug-eluting stent (DES) for transplant renal artery stenosis (TRAS). Therefore, we investigated outcomes of patients with clinically significant TRAS undergoing DES placement. METHODS: A retrospective review of patients with clinically significant TRAS undergoing percutaneous balloon angioplasty with DES from 2014 to 2021 was conducted. Patient demographics, procedural details, and follow-up outcomes were collected. Primary endpoints were the in-stent primary patency and graft survival. Secondary endpoints were freedom from reintervention and primary-assisted patency RESULTS: Thirteen TRAS in twelve patients with graft function alteration were treated with DES. The median age was 57 years (interquartile range (IQR), 48-63), and nine (75%) were male. The median follow-up was 9 months (IQR, 4-52). The median time from transplant to intervention was 5.8 months. TRAS was most commonly found at the proximal portion (92%). The procedure was performed with carbon dioxide angiography with minimal amount of contrast (median, 3 mL) under local and general anesthesia in nine (69%) and four (21%) TRAS, respectively. The rates of stenosis-free primary patency of the DES and graft survival were 75% and 100%, respectively. Three reinterventions for restenosis resulted from the kinking of the transplant renal artery proximal to the DES, which were treated by extending the stent more proximally into the origin of the transplant renal artery. The median time to reintervention was 0.9 months (range, 0.23-2 months). Freedom from reintervention and primary-assisted patency were 75% and 100%, respectively. CONCLUSIONS: Despite the lack of evidence in literature, these data demonstrate that DES is safe and effective in treating patients with TRAS at short to midterm. As all reinterventions after DES were performed due to kinking of the transplant renal artery proximal to the stent, bridging of the DES into the external iliac artery is recommended.
Recommended Citation
Chang, H., Gelb, B. E., Stewart, Z. A., Lonze, B. E., Garg, K., Rockman, C. B., Jacobowitz, G. R., Ali, N. M., & Cayne, N. S. (2022). Safety And Efficacy Of Drug-eluting Stents For Treatment Of Transplant Renal Artery Stenosis. Annals of Vascular Surgery, 49, 407. https://doi.org/10.1016/j.avsg.2021.12.060
