Endovascular treatment of iliac artery stenosis proximal to the transplanted kidney

D.K. de Vries, D. Molenaar, R.C. van Wissen, M.E.J. Reinders, C.S.P. van Rijswijk, A.F.M. Schaapherder, J.F. Hamming, I.P.J. Alwayn

Friday 16 march 2018

14:40 - 14:50h at Willem Burger Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 18: Clinical

Background

Proximal Iliac artery stenosis can occur years after kidney transplantation. With the increasing recipient age it may well reflect the natural course of atherosclerotic iliac disease. However, even without clinical manifestations, it may ultimately result in kidney allograft dysfunction. In patients with peripheral artery disease (PAD), percutaneous transluminal angioplasty (PTA) of iliac stenosis has become common practice in the last decades. This study aims to display the treatment options of transplanted patients who develop stenosis of the iliac segment proximal to the transplanted kidney (Prox-TRAS).

Methods

All patients presenting with Prox-TRAS from 1996 to 2017 were included in this retrospective cohort study. Kidney function (eGFR), blood pressure, clinical complaints, treatment, patency and complications were recorded.

Results

15 patients that developed Prox-TRAS were identified. Mean time from transplantation to symptomatic iliac stenosis was 77 months (SEM 13,9). Presenting symptoms were therapy refractory hypertension, decreased kidney function and claudication or distal ischemia. Iliac stenosis was diagnosed on duplex. All patients were primarily treated with angiography, PTA and stenting of the stenosed iliac trajectory, all with satisfying angiographic result. Mean eGFR increased from 40 (SD 12) to 50 (SD 15) ml/min at 6 months after treatment. Mean systolic BP decreased from 157 (SD 27) to 130 mmHg (SD 13) at 6 months after PTA. Mean diastolic BP decreased from 80 (SD 12) to 72 mmHg (SD 10). In all but one patient presenting with therapy refractory hypertension blood pressure decreased after PTA. There were no irreversible complications of angiography and PTA. Two patients developed groin hematoma, one patient developed a false aneurysm treated by trombin injections. One patient had a rupture of the common iliac artery during PTA which was immediately treated by covered stent placement. Within the mean follow up period of 51 months, 4 out of 15 patients developed recurrent stenosis requiring re-PTA. One patient developed severe in-stent stenosis and was ultimately treated by aortoiliac bypass graft.

Conclusion

In patients presenting with unexplained hypertension, loss of kidney function or claudication after kidney transplantation, proximal iliac stenosis should be considered. Iliac PTA with stenting is safe and despite use of contrast agents, kidney function improved and blood pressure decreased.