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      Estenose arterial nos transplantes renais Translated title: Arterial stenosis after renal transplantation

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          Abstract

          OBJETIVO: Relacionar a influência dos dois tipos de anastomoses arteriais empregadas (término-terminal e término-lateral), da idade do receptor, do rim de doador vivo ou cadáver e do uso de remendo aórtico ("patch") quanto à presença ou não de estenose da artéria renal e, avaliar o tratamento destas estenoses. MÉTODO: Estudo retrospectivo de 278 pacientes submetidos a transplante renal no Hospital Universitário Clementino Fraga Filho (HUCFF), de maio de 1989 a maio de 2001. RESULTADOS: Não se mostrou relação entre as variáveis estudadas com a presença ou não de estenose da artéria renal. A estenose da artéria renal foi detectada em oito casos, que foram tratados, com sucesso, mediante angioplastia transluminal percutânea (ATP), com implante primário de "stent" (n = 7) ou sem implante de "stent" (n = 1). CONCLUSÕES: As variáveis estudadas não influenciaram no aparecimento da estenose da artéria renal e o tratamento endovascular foi efetivo na correção destas lesões estenóticas.

          Translated abstract

          BACKGROUND: Our goal is to relate the type of anastomosis (end-to-end or end-to-side), the age of recipient patient, the type of renal graft used (live or cadaver donor) and the aortic patch usage to the development of renal artery stenosis, evaluating its treatment. Data were statistically analyzed using Fischer's Test. METHODS: This is a retrospective study of 278 patients, submitted to renal implant surgery at the Clementino Fraga Filho University Hospital, from May, 1989 to May, 2001. RESULTS: There was no demonstrable relation between the studied variables and the presence of stenosis. Renal artery stenosis was detected in eight cases, which were successfully treated through percutaneous transluminal angioplasty, with primary stent implant (n = 7) or without stent implant (n = 1). CONCLUSION: The analyzed variables didn't influence the development of renal artery stenosis. Endovascular treatment was effective for this pathology.

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          Most cited references35

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          TREATMENT OF RENOVASCULAR HYPERTENSION WITH PERCUTANEOUS TRANSLUMINAL DILATATION OF A RENAL-ARTERY STENOSIS

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            Transplant renal artery stenosis: experience and comparative results between surgery and angioplasty.

            One hundred thirty-eight patients with transplant renal artery stenosis (TRAS) were identified among 1200 patients undergoing renal transplantation in our university hospital. Severe systemic hypertension was the main symptom leading to a diagnosis of TRAS. Only 88 TRAS patients were given interventional treatment consisting of percutaneous angioplasty (PTA; n = 49) or surgical repair (SR; n = 39). The immediate success rate was 92.1% for SR and 69% for PTA. The long-term success rate was 81.5% for SR and 40.8% for PTA, with a follow-up period of 56.7 +/- 22.4 months (SR group) and 32 +/- 28.1 months (PTA group). PTA morbidity reached 28%, compared to 7.6% in the SR group. In spite of these results, we still favor PTA as a first line interventional treatment when TRAS is recent, linear, and distal and primary SR in cases of kinking and proximal TRAS.
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              Arterial stenosis complicating renal allotransplantation in man: a study of 38 cases.

              Of 306 renal transplantations, stenosis of the artery supplying the grafted kidney was found in 38 patients three months to two years after they had undergone renal transplantation. The diagnosis was made by arteriography done because of refractory hypertension with or without impaired renal function in 36 patients and as a routine investigation in two normotensive patients. The stenosis was corrected surgically in 14 patients, with resultant lasting relief of hypertension in ten patients and improvement of renal function in five out of six patients with impaired renal function. Different types of stenosis were recognized: stenosis of the recipient artery, stenosis of the suture line, stenosis of the donor renal artery (segmental or diffuse) and multiple forms. The most frequent site of stenosis was the donor artery. There seems to be no single cause of stenosis: atheroma of the recipient vessels, faulty suture technique, hemodynamic disturbances, trauma to donor or recipient arteries account for some cases, whereas in other cases the evidence points to an immune mechanism. This complication of renal transplantation may be more frequent than is thought at present; therefore, routine renal arteriography should be performed at repeated intervals in all transplanted patients.
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                Author and article information

                Journal
                rcbc
                Revista do Colégio Brasileiro de Cirurgiões
                Rev. Col. Bras. Cir.
                Colégio Brasileiro de Cirurgiões (Rio de Janeiro, RJ, Brazil )
                0100-6991
                1809-4546
                October 2005
                : 32
                : 5
                : 237-243
                Affiliations
                [01] orgnameUFRJ orgdiv1Faculdade de Medicina orgdiv2Cirurgia Vascular
                [03] orgnameHUCFF
                [02] orgnameUFRJ orgdiv1Faculdade de Medicina orgdiv2Departamento de Cirurgia
                Article
                S0100-69912005000500004 S0100-6991(05)03200504
                10.1590/S0100-69912005000500004
                133141a7-4505-4fd6-aea4-b29457d67fe6

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 21 February 2005
                : 29 July 2005
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 23, Pages: 7
                Product

                SciELO Brazil

                Categories
                Artigos Originais

                Kidney transplantation,balloon,Angioplasty,Renal artery obstruction,Transplante de rim,Angioplastia com balão,Obstrução da artéria renal

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