| Section 1 The angiographic classification of transplant renal arterystenosisObjectiveTo establish the angiographic classification of transplant renal artery stenosis (TRAS). Materials and MethodsThe angiographic manifestations in 33 patients with TRAS were retrospectively analyzed. According to stenotic locations, TRAS was classified as anastomotic stenosis (type I ), the truncal stenosis of transplant renal artery (type â…¡), the branch stenosis of transplant renal artery (type â…¢), recipient iliac artery stenosis (type â…¢). Type â… ,â…¡,â…¢ were respectively classified as A and B sub-types according to the stenotic length. The length of sub-type A stenosis was defined as 10mm, and there was definite borderline between pathological and normal artery, with post-stenosis dilation. Sub-type B stenosis was defined as a > 10mm long segment stenosis without post-stenosis dilation, and there were indefinite confines between pathological and normal artery. Results42 stenoses were showed by angiography in 33 patients with TRAS. Stenotic extents were 50%~95%(78.8% ?14.5%), and stenotic lengths were lmm~32mm(14? mm). The 42 stenoses were classified as type I A 6 cases, type â… B 11 cases, type â…¡A 4 cases, type II B 8 cases, type â…¢A 6 cases, type â…¢B 4 cases, type IV 3 cases. The incidences of type I , II stenosis were significant higher than type IV stenosis(P=0.002, P=0.02). ConclusionAnastomoses and the trunk of transplant renal artery are main sites of TRAS.-6-Determining angiographic classification of TRAS, it probably provides important information for us to choose different endovarscular therapeutic procedures.Section 2 The comparative study of efficacy of endovarscular treatmentsamong different types of transplant renal artery stenosisObjectiveTo compare the clinical effects of endovarscular treatments for different types of transplant renal artery stenosis. Materials and MethodsIn 31 patients with TRAS, percutaneous transluminal angioplasty (PTA group,n=23) and renal stenting (stent group, n=15) were respectively performed. The stent group included 5 patients replaced by stenting after unsuccessful PTA and 3 restenosis patients after PTA. The technological success rate, restenosis rate, clinical effects were analyzed. Results1. The technological success rate in PTA group(69.6%) was significant lower than stent group (100%, p=0.029) . In PTA group, the technological success rate was 72.7% for sub-type A and 60% for sub-type B. There was a significant low technological success rate in type II B (25%)compared with other stenotic types(p=0.033) in PTA group.2. In 6~34 months follow-up, 3 stenoses reccurred in 16 patients with successful PTA, and restenosis didn't appeare in 15 patients with stenting. The restenosis rate had no significance between PTA and stent group(p=0.226). The restenosis didn't occurred in all patients of type A. The restenosis rate of type B was 15.8%. The restenosis rate of PTA was 60% for type I B, which was significant higher than other types with PTA or stenting (p=0.0l8, p=0.009).3. The clinic effective (cure and improvement) rate of hypertension, renal function was respectively 83.3%, 77.8% in 1 week post-PTA. In 15 patients with renal stenting, the clinical effective rate of hypertension, renal function-7-was 86.7%, 86.7%. The difference of clinical effective rate of hypertensionand renal function was not significant among different stenotic types (p>0.05). ConclusionsThe high technological, clinical effective rate and lower restenosis rate may been achieved by PTA or stenting for type A stenosis. It suggests PTA is first choice for type A stenosis. There is a very low technological success rate in type II B stenosis with PTA, and high restenosis rate in type I B stenosis with PTA. It implies that renal stenting be feasible for type B stenosis.Section 3 The complications of endovarscular treatment for transplantrenal artery stenosisObjectiveTo investigate the causes and manag...
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