1. Renal Unit-Careggi University Hospital-Florence-Italy
EFFICACY AND SAFETY OF PALMAZ STENT INSERTION IN THE TREATMENT OF RENAL ARTERY STENOSIS IN KIDNEY TRANSPLANTATION
Bertoni E., Di Maria L., Zanazzi M., Rosati A., Piperno R., Moscarelli L., Salvadori M.
Renal Unit-Careggi University Hospital-Florence-Italy

2. BACKGROUND I BESIDE MEDICAL MANAGEMENT, TWO DIFFERENT TREATMENT MODALITIES ARE CURRENTLY AVAILABLE FOR PATIENTS WITH TRANSPLANT RENAL ARTERY STENOSIS. AS SURGICAL REVASCULARIZATION BEARS THE RISK OF HIGH MORBIDITY OF THE GRAFT, PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY HAS RECEIVED CONSIDERABLE ATTENTION AS A NONINVASIVE TREATMENT APPROACH

3. THERAPEUTICAL OPTIONS IN THE TREATMENT OF TRANSPLANT RENAL ARTERY STENOSIS

4. BACKGROUND II
PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY HAS A PERCENTAGE OF TECHNICAL SUCCESS OF 75-88%. MAIN LIMITS OF PTA ARE BOTH THE STENOSES OCCURRING AT THE ANASTOMOTIC SITE AND THE RECURRENCE OF STENOSIS AFTER A PREVIOUS SUCCESSFUL PTA.
IN SUCH CASES METALLIC STENTS HAVE BEEN PROPOSED TO TREAT ARTERY STENOSIS.

5. AIM OF THE STUDY
AIM OF THE STUDY WAS TO EVALUATE THE EFFICACY AND SAFETY OF PALMAZ STENT INSERTION IN THE CASE OF RECURRENCE OF RENAL ARTERY STENOSIS AFTER A PREVIOUS ANGIOPLASTY OR IN THE CASE OF SEVERE ANASTOMOTIC STENOSIS

6. PATIENTS AND METHODS I  A=Anastomotic site P=Post-anastomotic site
© E-S= End to side E-E= End to end

7. PATIENTS AND METHODS II
All patients with documented severe anastomotic stenosis or recurrence after PTA, were treated by Palmaz stent
TECHNIQUE OF STENT IMPLANTATION
Palmaz endoprothesis is a stainless tube crimped onto the same angioplasty balloon. The delivery system is withdrawn into the aorta leaving the stent in place mounted on the balloon. The balloon is inflated and the stent expanded. The stent is left in place, after the removal of the guide wire and balloon catheter

8. PEAK SYSTOLIC VELOCITY
MEAN BLOOD PRESSURE
Pre-stenting
Post-stenting ** **
***
mmHg
PEAK SYSTOLIC VELOCITY **
***
cm/sec
***
*p<0.05, **p<0.01, ***p<0.001

9. SERUM CREATININE
Pre-stenting
Post-stenting
p=NS
p=NS
p=NS

10. NUMBER OF HYPOTENSIVE DRUGS PRE AND POST STENTING

11. Mean Blood Pressure and peak systolic velocity,
pre and post stenting
PRE-STENT
POST-STENT
1 WEEK
1 MONTH
1 YEAR
M.B.P.=Mean Blood Pressure (mmHg) P.s.v.=Peak systolic velocity (cm/sec)

12. CONCLUSIONS
In the case of severe or recurrent transplant renal artery stenosis, the stenting of the renal artery proved to be in expert hands an effective therapeutic tool.
This method with low procedure costs and extremely low complication rate proved to be safe and to offer the potential of preserving lumen patency and so improving the long-term of angioplasty

13. PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY
PROS
LESS INVASIVE TECHNIQUE
EFFECTIVE IN NOT ANASTOMOTIC LESIONS
PROCEDURE EASILY REPEATABLE
CONS
INTIMAL LESIONS (FLAPS)
RESTENOSIS
NOT EFFECTIVE IN ANASTOMOTIC LESIONS

14. STENTING PROS CONS EFFECTIVE IN ANASTOMOTIC LESIONS
EFFECTIVE IN RESTENOSIS
GOOD LONG TERM RESULTS IN EXPERTED HANDS
CONS
MORE INVASIVE TECHNIQUE
ARTERY KINKING NEXT TO THE STENT
INTIMAL PROLIFERATION