Endovascular Treatment of Iliac Artery Stenosis Proximal to Renal Allografts
Godfrey R Parkerson, Philip A Rivera, Samuel R Money, Clayton Brinster, Hernan A Bazan, Charles Leithead, Laura Tran, W Charles Sternbergh
Ochsner Clinic Foundation, New Orleans, LA
INTRODUCTION: Despite the increasing frequency of renal transplantation and high prevalence of peripheral artery disease in the U.S., little is known about endovascular interventions for iliac occlusive disease proximal to a renal allograft. We reviewed the outcomes of renal transplant patients who underwent endovascular iliac artery interventions for delayed graft function, hypertension, and/or worsening chronic kidney disease at our institution.
METHODS: A retrospective review was performed at a single institution to identify patients with history of kidney transplant who underwent iliac artery endovascular intervention between Jan 1 2011 - 8/20/21. Demographics, outcomes, and peri-operative data were recorded and evaluated.
RESULTS: A total of 10 patients underwent primary endovascular interventions for acute delayed graft function (n=3), worsening chronic kidney disease (n=1), uncontrolled hypertension (n=1), and combined CKD with uncontrolled HTN (n=3) due to iliac artery stenosis. Two patients were clinically asymptomatic at the time of their intervention but had previous fluctuations in renal function and imaging evidence of severe iliac stenosis. Mean age of the patients at the time of intervention was 57.3 years (Range 29.9-75.2). Mean time from transplant to intervention was 5 years (range 0-19 yrs). Ultrasound confirmed or suggested iliac artery stenosis in 90% of patients who underwent intervention. One patient had primary PTA of the iliac artery and the remaining 9 patients had stenting of the iliac artery. Technical success was 100%. Mean contrast volume was 25ml (range 0-72ml), with half of cases utilizing CO2. One patient required a secondary endovascular procedure performed from the left radial artery for distal stenosis detected on initial surveillance ultrasound 2 weeks after her primary procedure. Mean follow up after intervention was 2.6 years. At last follow up, primary patency was 90% and primary assisted patency was 100%. Patients with uncontrolled hypertension as an indication for intervention all had improved blood pressure control with mean decrease of 2.5 antihypertensive medications. All patients with existing CKD at the time of their procedure (n=7) had a significant improvement in estimated GFR and creatinine (pre 22.2 +/- 9.6; post 52.1 +/-13.5; P <0.05).
CONCLUSIONS:Endovascular interventions for iliac artery occlusive disease can be performed safely in patients with prior renal transplants and provide marked improvement in allograft function. The majority of hemodynamically significant iliac stenosis can be detected with ultrasound. Patients with delayed graft function, uncontrolled hypertension, and/or worsening CKD after renal transplant should undergo ultrasound evaluation of the transplant and proximal iliac artery to detect iliac artery stenosis.
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