Combined percutaneous trans-renal and trans-femoral endovascular recanalization and angioplastic reconstruction of a disrupted transplant renal artery stent: A novel salvage technique

摘要

Renal artery stenosis (RAS) is the most common vascular complication following renal transplantation. Percutaneous endovascular transluminal angioplasty with stenting is the treatment of choice for clinically significant RAS. We present a case describing a novel combined trans-renal parenchyma and trans-femoral approach to repairing a disrupted transplant renal artery stent. Our patient’s allograft RAS was initially managed by 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 trans-femoral attempt, we were able to successfully access the renal arterial system via a combined trans-renal and trans-femoral approach, using an upper-pole artery through the renal parenchyma. This trans-renal approach used a 3 French system, allowing us to get a wire across the stent, which we were previously unable to do. With wire access, we 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 re-operative repair without immediate complication and provides a method for vascular access to the renal arterial system in select patients.