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Transplantation - Practical Manual of Abdominal Organ Transplantation - 2002

Transplantation - Practical Manual of Abdominal Organ Transplantation - 2002

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Published by: basyony1970 on Feb 29, 2012
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22.2.2.1a.Renal Artery Stenosis.This can be present in up to 10% of

transplantpatients. Early stenosis at the anastomosis is probably a technical
problem. Later, distal stenoses could result from rejection or turbulence and may
present as hypertension. Ultrasound is a noninvasive modality useful in screening
for arterial stenosis. SpecificDoppler criteria, such as increased velocity, velocity
gradients, and spectral broadening, have been developed. Scintigraphy can also be
used to diagnose arterial stenosis. Findings are similar to chronic rejection except
when performed with angiotensin-converting enzyme inhibitors, when the condi-
tion resembles renal artery stenosis in native kidneys. MRA can also accurately
depict stenoses. A conventional arteriogram can then be performed. Carbon
dioxide angiography is an alternative for patients with renal insufficiency or
contrast allergy. Stenoses should be treated with percutaneous angioplasty, with
surgery for recurrent stenoses. Percutaneous intravascularstent placement is
another option.

22.2.2.1b.Renal Artery Thrombosis.This is rare and present in < 1% of
patients. Ultrasound shows no intrarenal arterial and venous flow. Magnetic
resonance can identify parenchymal areas of necrosis and absence of flow in the
vessel. Findings can be confirmed with angiography. Surgical exploration is
indicated.

22.2.2.1 c.Renal Vein Stenosis.This condition is rare. It may result from
perivascular fibrosis or compression from adjacentcollection. Sonography shows
increased velocities similar to arterial stenosis. Venography can be performed, if
necessary, to confirm the diagnosis.

228

Juan Oleaga

22.2.2.1d.Renal Vein Thrombosis.More common in diabetics, renal

vein thrombosis may be related to cyclosporine use, presenting within a week after
transplant as oliguria and an enlarged, painful kidney. Ultrasoundshows an
enlarged kidney with a reversed diastolic arterial waveform and absent venous
flow. Thrombus may be identified in an enlarged vein. MRI shows an enlarged
kidney with areas of infarction, lack of enhancement on MRA, and nonvisualiza-
tion of the renal vein. A surgical thrombectomy may sometimes be possible.

22.2.2.1e.Pseudoaneurysms and Arteriovenous (AV) Fistulas.These

can result from surgical technique, percutaneous biopsy, or infection. Small
intrarenal pseudoaneurysms may resolve spontaneously. Larger lesions can cause
ischemia,hematuria, or hemoperitoneum. Pseudoaneurysms mimic a cyst on
ultrasound and have disorganized flow. AV fistulas in ultrasonography have a
feeding artery with a high-velocity, low resistance waveform and a pulsatile
draining vein. Intraparenchymal pseudoaneurysms may be embolized percutane-

ously.

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