Author/Editor		Popovič, Peter; Šurlan, Katarina
Title		Interventional radiological management of complications in renal transplantation
Translated title		Radiološka diagnostika in zdravljenje zapletov presajene ledvice
Type		članek
Source		Radiol Oncol
Vol. and No.		Letnik 38, št. 4
Publication year		2004
Volume		str. 309-21
Language		eng
Abstract		Background. The most frequent radiologically evaluated and treated complications in renal transplantation are perirenal and renal fluid collection and abnormalities of the vasculature and collecting system. Renal and perirenal fluid collection is usually treated successfully with percutaneous drainage. Doppler US, MRA and digital subtraction angiography (DSA) are most important in the evaluation of vascular complications of renal transplantation and management of the endovaseular therapy. Conclusions. Stenosis, the most common vascular complication, occurs in 1% to 12% of transplanted renal arteries and represents a potentially curable cause of hypertension following transplantation and/or renal dysfunction. Treatment with percutaneous transluntinal renal angioplasty (PTRA) or PTRA with stent has been technically successful in 82 to 92% of the cases, and graft salvage rate has ranged from 80-100%. Complications such as arterial and vein thrombosis are uncommon. Intrarenal A/V fistulas and pseudoaneurysms are occasionally seen after biopsy, the treatment reguires superselective embolisation. Urologic complications are relatively uncommon; they consist predominantly of the urinary leaks and urethral obstruction. Interventional treatment consists of percutaneous nephrostomy, balloon dilation, insertion of the double J stents, metallic stent placement and external drainage of the extrarenal collections. The aim of the paper is to review the role of interventional radiology in the management of complications in renal transplantation.
Summary		Izhodišča. Namen članka je podati pregled vloge intervencijske radiologije v diagnostiki in zdravljenju zapletov po presaditvi ledvic. Zapleti nastanejo na žilah, sečnih izvodilih ter v ledvici in njeni okolici v obliki patoloških tekočinskih formacij. Diagnostiko, načrtovanje in vodenje znotrajžilnega zdravljenja žilnih zapletov opravljamo z Dopplerskim ultrazvokom (UZ), magnetno resonanco (MR) in z digitalno subtrakcijsko angiografijo (DSA). Zaključki. Najpogostejši žilni zaplet presajene ledvice je zožitev ledvične arterije, ki se pojavi pri 1% -12% bolnikov. Nezdravljena zožitev je lahko razlog za arterijsko hipertenzijo in odpoved ledvice, čeprav je zaplet potencialno ozdravljiv. Zožitev zdravimo s perkutano transluminalno ledvično angioplastiko (PTRA) z uporabo žilne opornice ali brez nje, ki je za hipertenzijo uspešna v 82% - 92% primerov, ohranitev presajene ledvice pa je možna v 80% - 100%. Zapleti, kot sta arterijska in venska tromboza, so redki. Po biopsijah se občasno pojavijo znotraj ledvične arteriovenske fistule in psevdoanevrizme, ki jih zdravimo s superselektivno embolizacijo. Najpogostejši urološki zapleti so zožitve, zapore in fistule sečevodov, ki jih zdravimo s perkutano nefrostomo, balonsko dilatacijo, vstavitvijo dvojne J kateterske opornice ali kovinske opornice. Tekočinske patološke kolekcije, kot so limfokele, abscesi, hematomi zdravimo s perkutano drenažo.
Descriptors		KIDNEY TRANSPLANTATION RADIOLOGY, INTERVENTIONAL RENAL ARTERY OBSTRUCTION LYMPHOCELE HEMATOMA ANEURYSM, FALSE URETHRAL OBSTRUCTION ANGIOPLASTY, BALLOON STENTS