Metal stent placement for two patients with post-transplantation renal artery stenosis, using intravascular ultrasound imaging.

Abstract

Post-transplantation renal artery stenosis is recognized at relatively early periods after renal transplantation. We report herein our experience of utilizing transluminal expanded metal stents (Palmaz stent and Wall stent) for post-transplantation renal artery stenosis, and monitoring with intravascular ultrasound (IVUS) imaging. The recipients were a 51-year-old woman (case 1) and a 57-year-old man (case 2), and the grafts were procured from cadaveric donors. Renal function had deteriorated suddenly at 5 months after renal transplantation in case 1 and at 86 months in case 2. The cause of the graft dysfunction was renal arterial stenosis. Color doppler ultrasound imaging and angiography diagnosed post-transplantation renal artery stenosis. The renal artery stenosis was serious, being greater than 90% in both patients. Percutaneous transluminal angioplasty (PTA) was performed, but its effectiveness was not sufficient; therefore, an indwelling endoluminal metallic Palmaz stent and an indwelling Wall stent were placed at the sites of stenosis while monitoring was done with IVUS. No complications were recognized at all. The length and degree of stenosis location became clear by using IVUS, and suitable stents could be selected for the renal artery stenosis. The clinical effect was excellent; the renal function improved to the pre-hospitalization value. We conclude that the Palmaz stent and the Wall stent were useful as a noninvasive strategy for treating post-transplantation renal artery stenosis. This procedure could be performed safely and surely using IVUS.