Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492013000200014
Jornal Vascular Brasileiro
Case report

Endovascular treatment of external iliac vein stenosis caused by graft compression after kidney transplantation

Tratamento endovascular de estenose de veia iliaca externa, em pos-operatorio de transplante renal, por compressao pelo enxerto

Willamax Oliveira de Sousa; Francisco Henrique Peixoto da Silva; Roberto Jamacaru Aquino Filho; Danilo Rocha Paz

http://dx.doi.org/10.1590/S1677-54492013000200014 J Vasc Bras, vol.12, n2, p.170-173, 2013
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Abstract

A 57-year old patient presented with approximately 80% stenosis of the left external iliac vein due to compression by the renal graft after kidney transplantation. The initial clinical manifestation of this vascular complication was progressive edema of the left lower limb, starting in the foot during the immediate postoperative period and reaching the thigh. Renal function also deteriorated during the first four months after transplantation. Venous Doppler ultrasound findings were suggestive of a diagnosis of extrinsic compression by the kidney graft and so phlebography was ordered, confirming stenosis of the left external iliac vein. The patient was initially treated with balloon angioplasty, but there was still residual stenosis so a stent was inserted, eliminating the stenosis. The edema reduced over time and the patient's renal function improved. While vascular complications are rare, and potentially severe, events, success rates are good if treatment is started early.

Keywords

kidney transplantation, postoperative complications, angioplasty

Resumo

Paciente com 57 anos apresentou estenose de aproximadamente 80% de veia ilíaca externa esquerda, devido a compressão pelo enxerto renal após o transplante de rim. A complicação vascular manifestou-se clinicamente com edema em membro inferior esquerdo, de caráter progressivo, que se iniciou no pé, durante o pós-operatório imediato, e progrediu até a coxa, associando-se a deterioração da função renal durante o intervalo de quatro meses após o transplante. O diagnóstico de compressão extrínseca pelo enxerto renal foi sugerido pelo eco-Doppler venoso, sendo, então, realizada flebografia, que confirmou estenose de veia ilíaca externa esquerda. O tratamento foi realizado com angioplastia por balão, porém a estenose residual persistiu, optando-se, então, pela colocação de stent, com correção da estenose. O paciente evoluiu com regressão do edema e melhora da função renal. Embora as complicações vasculares sejam eventos raros e potencialmente graves, existe um bom percentual de sucesso com a terapêutica precoce.

Palavras-chave

transplante de rim, complicacoes pos-operatorias, angioplastia

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