- Radiological diagnostic methods have a significant role in the preoperative and postoperative care of patients after kidney transplantation. Improvement and innovations in technology, but also the ...growing experience of the radiologists who deal with kidney transplant patients as part of the transplant team lead to earlier detection of complications in the postoperative period, which are the leading cause of transplant failure. In this article, we describe, through diagnostic imaging examples, detailed evaluation of all possible complications that can occur after kidney transplantation, with evaluation of different possible diagnostic methods that can be used in the preoperative assessment and postoperative follow up and care of the transplanted patient. The goal of this article is to demonstrate and summarize in detail the possible complications of renal transplantation and how to best diagnostically approach them, with special reference to ultrasound which is the main imaging method for this group of conditions.
Background
Percutaneous mechanical thrombectomy (PMT) is a well-established technique for treatment of acute arterial and venous thrombosis which inevitably leads to intravascular erythrocyte ...hemolysis, resulting in hemoglobinuria.
Case presentation
We present a case of 66-year-old Caucasian female with subclavian artery aneurysm causing distal embolization and hand ischemia. The aneurysm was treated with stent graft, but with a subsequent graft thrombosis 3 months later. After graft recanalisation, AngioJet PMT was performed which resulted in dialysis-requiring acute kidney injury.
Conslusion
Only several cases of acute kidney injury following AngioJet PMT have been published in literature. To our knowledge, this is the first reported case of dialysis-requiring AKI after PMT for peripheral arterial thrombosis. Until there is sufficient evidence and recommendation on preventing AKI in this setting, we believe that by being aware of the risk and by monitoring of patient, one might minimize the damage in case it occurs.
The aim of this study was to determine arterial stiffness and the effect of stenting in patients with renal artery stenosis. We hypothesized that ostial renal artery stenosis is not only a marker of ...more pronounced atherosclerosis of large arteries, but is also a predictor of higher cardiovascular mortality. We enrolled 33 patients with renal artery stenosis refractory to pharmacological treatment and divided them according to the renal artery stenosis location, ostial and truncal (23
. 10 patients). We analyzed patient survival at five-year follow up. After the intervention and at six-month follow up, there was a significant decrease in blood pressure values, as well as in pulse wave velocity (PWV) and augmentation index. PWV was significantly lower in patients with truncal renal artery stenosis and these patients were significantly younger. Twelve patients with ostial and one patient with truncal renal artery stenosis (52%
. 10%, p<0.001) died from cardiovascular events. Our study is the first to confirm the predictive role of PWV and arterial stiffness in patients with renal artery stenosis, especially ostial one, and to emphasize its ability of detecting future higher incidence of cardiovascular events.
Abdominal aortic thrombosis is a rare entity in neonates and has mostly been associated with umbilical artery or cardiac catheterization. We present a complicated case of an otherwise healthy neonate ...who developed thrombosis of abdominal aorta with renal failure. Therapy with intravenous heparin was unsuccessful, and thrombolysis was contraindicated because of disseminated intravascular coagulation so we decided to perform open thrombectomy using the left retroperitoneal approach. The following day, thrombosis recurred in the same extent and despite high risk of bleeding Alteplase was eventually given, which resulted in recanalization of the aorta 6 hours later. Renal function recovered, dialysis was discontinued, and further course was uneventful. The treatment of abdominal aortic thrombosis in neonates should be considered on a case-by-case basis because the available data on the condition are limited to case report and series. If open thrombectomy is performed, retroperitoneal approach should be preferred because it allows for easy institution of peritoneal dialysis should the need arise.
Thoracic duct injury is a rare complication of left subclavian vein catheterization. A significant injury could lead to chylothorax, a condition with high mortality rate if not treated. It is ...diagnosed with lymphography or by laboratory tests of pleural fluid aspirate. A 51year old Caucasian male with a history of unregulated hypertension presented to our Emergency department (ED) with anginous symptoms and increased serum creatinine level. After the placement of a temporary central venous catheter for hemodialysis in left subclavian vein, he developed lymph leakage on puncture site beside the catheter, at drainage rate of 75ml/h. In the absence of more serious clinical symptoms, conservative treatment with close patient monitoring and diet changes was chosen, rather than more invasive treatment options.
There is a correlation between central venous cannulation and the development of central venous stenosis. Minor retrosternal vein lesions can be easily missed. Computerized tomographic (CT) ...venography is the diagnostic procedure of choice. The aim of this study was to examine the complications after catheter implantation in patients with prior permanent catheter placement and to evaluate present diagnostic procedures performed prior to choosing permanent access site in order to reduce possible complications after catheter placement. Complications of permanent CVC insertion in our department were analyzed between October 2011 and February 2015. We have implanted the Tesio twin catheter system and the Hickman Bard dual lumen catheter. All patients with prior permanent dialysis catheter were evaluated with color doppler, while patients with suspected central venous stenosis (CVS) or thrombosis were evaluated with phlebography or CT venography prior to catheter placement. One hundred and ninety‐eight permanent dialysis catheters were placed (173 Tesio 87.4% and 25 Hickman 12.6%) in 163 patients. There were 125 patients (76.7%) with prior temporary catheter and 61 (48.8%) of them had more than one prior permanent catheter (1.92 catheter per person).There were 4/61 (6.5%) patients with catheter‐related complications without prior phlebography and CT venography. Phlebography and CT venography were performed in 30 (24.0%) patients with suspected CVS/thrombosis and with dialysis vintage of 76.23 months (52.78–98.28). Phlebography and CT venography were more sensitive than color doppler in the detection of CVS/thrombosis in patients with prior permanent catheter placements (P < 0.001). Since this diagnostic algorithm was introduced prior to catheter placement there were no catheter insertion‐related complications or dysfunctions (P < 0.001). All our procedures on patients with prior permanent catheters followed preliminary color doppler diagnostics. Nevertheless, in four cases, the vessel obstruction and abnormality led to catheter insertion‐related complications. When phlebography and CT venography was performed before the procedure in patients with prior permanent catheters and one or more CVS or thrombosis, early and late catheter‐related complications were avoided by careful selection of the least injured vein and planning of procedure. When planning a permanent dialysis catheter placement in patients with prior multiple CVC, phlebography and CT venography may be diagnostic procedures of choice for avoidance of early catheter dysfunction and CVC placement complications.
Cilj: Kompjutorizirana tomografska angiografija (CTA) zlatni je standard za otkrivanje endoleaka nakon endovaskularnog liječenja aorte (EVAR). Cilj je ovog rada utvrditi može li kontrastni ultrazvuk ...(CEUS) zamijeniti CTA u dijagnostici endoleaka nakon EVAR-a. Materijali i metode: Pregled literature na engleskom jeziku proveden je u bazama podataka: PubMed/MEDLINE, ScienceDirect, Google Scholar. Ključne riječi bile su: “Computed tomography angiography”, “Contrast enhanced ultrasound”, “Endovascular aneurysm repair”, “Endoleak”. Studije koje su odgovarale kriterijima uključivanja recenzirane su u cijelosti te je odabrano 39 studija. Rezultati: Pacijenti su u analiziranim studijama najvećim dijelom bili muškarci (86 %). Medijan dobi iznosio je 74 godine. Endoleak nakon EVAR-a promatran je u infrarenalnih (79 %), jukstarenalnih (17 %) i suprarenalnih aneurizama (4 %). Stopa endoleaka kretala se između 3 i 52 %. Najčešći endoleak bio je po tipu II te se u 15 % slučajeva javljao unutar prvih šest mjeseci, odnosno u manje od 10 % slučajeva unutar dvije godine nakon EVAR-a. Za sve tipove endoleaka CEUS je pokazao uravnoteženu osjetljivost, specifičnost i područje ispod krivulje od 94 %, 88 % i 96 %. U odnosu na CTA, CEUS ima veću osjetljivost (94/83 %), ali lošiju specifičnost (94,8/99 %). Specifično za tip II endoleaka, CEUS je imao veću stopu detekcije (36,88/20,88 %). Visoka osjetljivost (97 %) i specifičnost (100 %) obilježje su CEUS-a u prikazu endoleaka tipa I i III, bez prednosti u odnosu na CTA. Zaključci: CEUS je slikovna metoda ravnopravna CTA u probiru pacijenata za endoleak nakon EVAR-a. CEUS ne može u potpunosti nadomjestiti CTA, no sigurna je i efikasna alternativa za korištenje u pacijenata bez CTA komplikacija nakon jednogodišnjeg kontrolnog intervala.
Aim: Computed tomography angiography (CTA) is the mainstay in endoleak detection after endovascular aneurysm repair (EVAR). The objective of this review is to determine if contrast enhanced ultrasound (CEUS) is able to replace CTA in monitoring endoleaks in patients after EVAR. Materials and methods: The literature search of Englishlanguage articles was conducted in PubMed/MEDLINE, ScienceDirect, Google Scholar. The used keywords included: “Computed tomography angiography”, “Contrast enhanced ultrasound”, “Endovascular aneurysm repair”, “Endoleak”. Studies appearing to meet inclusion criteria were reviewed in full and 39 studies were included. Results: In analysed studies, patients were predominantly men (86%) and median age was 74 years. Endoleak after EVAR was followed in infrarenal (79%), juxtarenal (17%) and suprarenal aneurysms (4%). Endoleak detection rate was 3-52%. Type II endoleaks were the most frequently encountered – in 15% of cases during the first six months and in less than 10% of cases during the first two years after EVAR. In diagnosing all endoleaks, CEUS demonstrated sensitivity, specificity, and AUC of 94%, 88%, 96%, respectively. Compared to CTA, CEUS possesses higher sensitivity (94/83%), but lesser specificity (94.8/99%). Particularly in type II endoleak evaluation, CEUS provided higher detection rates (36.88/20.88%). Regarding type I and type III endoleaks, CEUS demonstrated high sensitivity (97%) and specificity (100%), but without superiority over CTA. Conclusions: CEUS is an imaging technique equivalent to CTA in screening for post-EVAR endoleaks. CTA cannot be entirely replaced by CEUS; however, it is safe and effective alternative method to use after one year of negative CTA exams.
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