P209 Introduction Results Objectives Case Report Conclusions Methods

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Presentation transcript:

P209 Introduction Results Objectives Case Report Conclusions Methods SUCCESSFUL TREATMENT OF TRANSPLANT RENAL ARTERY PSEUDOANEURYSM USING A COMBINATION OF A STENT AND EXPANDABLE HYDROGEL TECHNOLOGY COILS - A CASE REPORT Yazin Marie1, Avneesh Kumar1, Simon Curran1, Peter Brown2, Douglas Turner2 Badri Shrestha1 1. Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust , United Kingdom. 2. Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom Clinical, Kidney, Other P209 Introduction Results Transplant renal artery (TRA) pseudoaneurysm can result in bleeding, infection, graft dysfunction or loss1. Expandable hydrogel technology has been described as a successful treatment of intracranial and peripheral pseudoaneurysms but no data is available in using them for TRA pseudoaneurysm2,3,4. Good radiological results were obtained and dramatic improvement in renal functions followed the intervention with a fall in creatinine level to 159 umol/L (eGFR 47 ml/min/1.73m2). A follow-up CT angiogram one month after the intervention showed a patent TRA with successful coiling of the pseudoaneurysm, satisfactory position of the stent with no evidence of TRA stenosis and an uneventful recovery. The patient continues to be followed up as an outpatients and the serum creatinine at 1 years was 150 umol/L (eGFR 49 ml/min/1.73m2). Objectives We present a case where the TRA pseudoaneurysm was successfully treated using an expandable hydrogel technology coils (HTC) in combination with a stent. Case Report A 38-year- old male presented with deterioration in renal functions (RF) five months following donation after circulatory death (DCD) renal transplantation with rise in creatinine to 633 umol/L (eGFR 13 ml/min/1.73m2) from an average of 145 umol/L (eGFR 52 ml/min/1.73m2). His initial and repeat ultrasound scans (USS) showed a well-perfused graft with normal resistive indices (RIs). A renal transplant biopsy showed features of acute cell-mediated rejection, which was treated with pulses of steroids without any success. A repeat USS showed new features of damped intra-renal arterial blood flow with RIs ranging between 0.4 and 0.45 and high velocities at the TRA origin suspicious of TRA stenosis. A CT angiogram confirmed a tight TRA stenosis in addition to a 20mm x 25mm pseudoaneurysm of the aortic patch arising at the same level as the TRA compressing its origin. With the approval from multidisciplinary team meeting and patient’s consent, he underwent radiological intervention as described below. Fig. 1 : 2 cm pseudoaneurysm arising from the patch. Fig. 2: TRA stenosis caused by external compression. Fig. 3: Successful coiling and stenting of the TRA. Conclusions Hydrogel coils can be used to treat TRA pseudoaneurysms achieving excellent volumetric filling and targeted embolisation. It offers a new non- invasive technique to preserve renal grafts. Methods References Through a left common femoral artery access, the TRA was catheterised and the false aneurysm was embolised using two 20mm Framing coils and packed with hydrogel coils. Subsequently, the stenosed TRA was stented using a 6x 20mm stent with good radiological results. 1 Dimitroulis D, Bokos J, Zavos G, Nikiteas N, Karidis NP, Katsaronis P, Kostakis A. Vascular complications in renal transplantation: a single-center experience in 1367 renal transplantations and review of the literature. InTransplantation proceedings 2009 Jun 30 (Vol. 41, No. 5, pp. 1609-1614). 2 Kallmes DF, Fujiwara NH. New expandable hydrogel-platinum coil hybrid device for aneurysm embolization. American Journal of Neuroradiology. 2002 Oct 1;23(9):1580-8. 3. Deshaies EM, Adamo MA, Boulos AS. A prospective single-center analysis of the safety and efficacy of the hydrocoil embolization system for the treatment of intracranial aneurysms. Journal of neurosurgery. 2007 Feb;106(2):226-33. 4. White PM, Lewis SC, Nahser H, Sellar RJ, Goddard T, Gholkar A, HELPS Trial Collaboration. HydroCoil Endovascular Aneurysm Occlusion and Packing Study (HELPS trial): procedural safety and operator-assessed efficacy results. American Journal of Neuroradiology. 2008 Feb 1;29(2):217-23.