Casuistry
Endovascular treatment of stenosis of the renal artery in transplanted kidney
Tratamiento endovascular de la estenosis de la arteria renal en el riñón trasplantado
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Ochoa, A. Breda, J. Martí, P. de La Torre, H. Villavicencio" "autores" => array:5 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Ochoa" "email" => array:1 [ 0 => "carolinaochoa82@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Breda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Martí" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "P." 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It has been shown that the grafts with TRAS have poorer long-term prognosis, causing even the loss thereof.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The importance of early diagnosis lies in the fact that after correction of the TRAS the graft function can be improved or stabilized.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Doppler ultrasonography (DUS) is a noninvasive and low cost method that provides information on the hemodynamic changes related to the TRAS, considered an ideal diagnostic tool.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The objectives of the study are to assess the efficacy of percutaneous transluminal angioplasty with stent (PTAS) taking into account the technical success and clinical outcome of patients in the short and medium term; additionally, the assessment of the DUS as a diagnostic and follow-up tool in the TRAS.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">From September 2005 to August 2009, we performed 298 kidney transplants at our center, 22 diagnosed with TRAS, and of these 13 (60%) subsidiary of PTAS, for showing a TRAS greater than 70% with associated impaired graft function.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A retrospective review was performed by calculating gross and percentage figures for the estimated parameters. The follow-up data were analyzed at 3, 12, and 36 months with creatinine, glomerular filtration (GF), and post-intervention DUS values.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In all cases, the indication was TRAS diagnosed by DUS, considering direct parameters (PSVs velocity at the stenotic site and index of stenotic site velocity, PSVs/PSVi velocity in the iliac artery), and indirect parameters (intraparenchymal arterial waveform morphology).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Success was defined as the art of correct placement of the stent and absence of complications arising therefrom, and clinical success as improved renal function and blood pressure during the follow-up.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">The incidence of TRAS in our center was 7.3% (22 patients) and 60% of these (13 patients) were subsidiary of PTAS. The causes of suspected TRAS were raised creatinine in 13 patients (100%) and poorly controlled BP in one patient (7.7%).</p><p id="par0050" class="elsevierStylePara elsevierViewall">The strictures treated were preferably of ostial location 61%, 54% short in length and with a flow occlusion greater than 70% (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The technical success of the intervention was 100% (13/13) and the clinical success 84.6% (11/13), showing a clear improvement in creatinine and glomerular filtration values, remaining stable during the follow-up. In the remaining 15.4%, there were no changes in renal function after the procedure (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">There was a significant initial improvement of clinical parameters with a subsequent stabilization of the graft function in all patients (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">In DUS control after the intervention, taking into account the direct parameters, there was decreased velocity in the stenotic site greater than 70% in 10 cases (84%); three cases (26%) reached decreases up to 60%. As for the indirect parameters, wave changes from type III to type II were registered in nine patients (69%) and to type I in four patients (33%). During the follow-up, these parameters remained stable (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">The incidence of TRAS reported in the literature varies widely from 2 to 23%,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> which can be explained by the heterogeneity of criteria to define the diagnosis. The most common clinical presentation is <span class="elsevierStyleItalic">de novo</span> or difficult to manage AHT associated with graft dysfunction.</p><p id="par0075" class="elsevierStylePara elsevierViewall">There are three main types of TRAS: a) stenoses of the anastomosis; b) stenoses proximal or distal to the anastomosis; and c) multiple or diffuse stenoses. The stenoses of the anastomosis are associated with the suture technique, most often in the end-to-end ones.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In the termino-lateral stenoses, there is an associated hemodynamic mechanism (vascular acute angle and artery kingking), and they are usually located in the postanastomotic area.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Other causes described are traumatisms during the removal or transplant, inappropriate cannulation (flaps or dissection of the intima), prolonged cold ischemia,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> CMV infection, recipient atheromatosis, immune disorder,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and use of cyclosporin A.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Noninvasive diagnostic techniques have been proposed with low profitability (plasma renin, isotope renogram). The DUS is the best initial diagnostic tool for the TRAS, with a sensitivity of up to 100% and a specificity of 85%.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Despite being an operator-dependent tool, it is noninvasive, innocuous, and low cost compared to other methods such as angioresonance or angiography.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In our center, DUS is performed to all transplanted patients after surgery, three months and one year after transplant; in case of suspected TRAS it is the first diagnostic tool used.</p><p id="par0095" class="elsevierStylePara elsevierViewall">For the diagnosis of the TRAS with DUS, direct and indirect parameters are taken into account. The direct ones assess the renal artery, the PSVs velocity at the stenotic site, and index of stenotic site velocity and PSVs/PSVi velocity in the iliac artery, which in the TRAS are >150<span class="elsevierStyleHsp" style=""></span>cm/s, and >2, respectively<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The indirect ones assess the intrarenal flow according to the intraparenchymal arterial waveform morphology. The appearance of type III waves (tardus-parvus) translate an intrarenal resistance index decreased by the turbulent flow caused by the TRAS<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Although spontaneous regression of the TRAS has been described, the clinically significant stenoses (>70% obstruction with a pressure gradient >15<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg) are subsidiary of treatment,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> since in most cases they are accompanied by renal function deterioration and a tendency to progression with a high risk of graft loss.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Percutaneous transluminal angioplasty of the renal artery with PTAS stenting is the best method for the initial treatment; success depends on the experience of the center and the type of injury.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The stenoses of the end-to-end anastomoses have a lower success rate.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">In the literature, complications are described in up to 10% of the cases (hematoma, artery dissection or rupture, thrombosis, recurrence).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> There is a greater technical challenge in the placement of the arterial stent in a transplanted kidney than in one's own, since a small portion of the stent should be lodged in the iliac artery light and this has a significantly smaller caliber than the aorta (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). Greater precision and a team of experienced interventional radiology are required to improve the effectiveness of the technique.</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">The patients subsidiary to treatment with PTAS at our center are those having stenosis greater than 70% of the caliber, of preferably ostial or yuxtaostial location and with significantly impaired graft function (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>).</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">The patients with failed PTAS or very severe or inaccessible stenoses may require surgical intervention, resection and revision of the anastomosis, bypass with saphenous, endarterectomy, or vascular proteses. This being a complex procedure for variable anatomy and extensive fibrosis, it is associated with a significant risk of graft loss in up to 15–20%,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> ureteral injury, and reintervention.</p><p id="par0125" class="elsevierStylePara elsevierViewall">The main limitation of our study is the low number of cases and the lack of long-term follow-up. Conducting a prospective, controlled, and with prolonged follow-up study would make it possible to assess both the graft survival and the complications from long-term PTAS.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0130" class="elsevierStylePara elsevierViewall">TRAS is the most common vascular complication after the transplant, and it deteriorates the graft function, leading even to the loss thereof. Early and appropriate diagnosis is vital as it is a potentially curable entity. DUS is the tool of choice for the diagnosis and follow-up of the TRAS. PTAS is the technique of choice for the TRAS treatment, as it keeps good vascular permeability in the short and medium term, ensuring adequate graft function.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres101637" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Materials and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec88804" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres101636" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec88803" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec88804" "palabras" => array:4 [ 0 => "Renal transplant" 1 => "Renal artery stenosis" 2 => "Percutaneous transluminal angioplasty" 3 => "Endoluminal stenting" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec88803" "palabras" => array:4 [ 0 => "Trasplante renal" 1 => "Estenosis de la arteria renal" 2 => "Angioplastia con balón" 3 => "Stents endoluminales" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The incidence of renal artery stenosis in the transplanted kidney (TRAS) varies between 2 and 23%, being the most frequent vascular complication following renal trasplantation. The delay in diagnosis and treatment can lead to functional graft loss. Percutaneous transluminal angioplasty with stent (PTAS) is the treatment of choice to restore kidney perfusion.</p> <span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Retrospective review of renal transplant casuistic in our institution between September 2005 and August 2009 was included in patients with greater than 70% TRAS and impaired graft function, treated with PTAS. Follow-up at 3, 12 and 36 months was done with creatinine, glomerular filtration rate (GFR) and Doppler ultrasonography (DUS). Technical success was defined as correct stent placement associated with decreased flow, and clinical success as improved renal function during follow-up.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Incidence of TRAS was 7.3% (22/298), 60% PTAS subsidiary. 100% technical success and 84.6% clinical success, 15.4% without changes in renal function. 84% decreases flow rate greater than 70% by DUS, and 26% up to 60%. Wave changes from type III to type II were recorded in 69% and to type I in 33%.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The PTAS is a safe and effective procedure for the treatment of selected TRAS patients, as it preserves vascular permeability in the short and medium term, ensuring the functionality of the graft. DUS is the method of choice for diagnosis and monitoring TRAS.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La incidencia de estenosis de la arteria renal en el ri¿nón trasplantado (EART) varía entre el 2 y el 23%, siendo la complicación vascular más frecuente del trasplante renal. Retrasar el diagnóstico y tratamiento puede llevar a la pérdida funcional del injerto. La angio-plastia transluminal percutánea con stent (ATPRS) es el tratamiento de elección en pacientes seleccionados.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Revisión retrospectiva de la casuística de trasplante renal de nuestro cen-tro entre septiembre de 2005 y agosto de 2009, incluyendo EART mayores al 70% con alteración funcional del injerto tratados con ATPRS. Seguimiento a los 3, 12 y 36 meses con valores de creatinina, filtrado glomerular (FG) y ultrasonografía doppler (USGD). Se consideró éxito téc-nico el correcto emplazamiento del stent y éxito clínico la mejoría de la función renal durante el seguimiento.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La incidencia de EART fue del 7,3% (22/298), 13 pacientes con EART mayor al 70% fueron subsidiarios de ATPRS. Hubo un éxito técnico del 100% y un éxito clínico del 84,6% (11 casos); Un 15,4% (dos casos) permanecieron sin cambios en la función renal. La disminución en la velocidad flujo mayor al 70% se controló con USGD; 10 casos (84%) y 3 (26%) disminuciones hasta del 60%. Se registraron cambios de ondas tipo III a tipo II en 9 casos (69%) y a tipo I en 4 (33%).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La ATRPS es una técnica segura y efectiva para el tratamiento de la EART en pacientes seleccionados, ya que mantiene una buena permeabilidad vascular a corto y mediano plazo, garantizando la funcionalidad del injerto. La USGD es la herramienta de elección para el diagnóstico y seguimiento de la EART.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Ochoa C, et al. Tratamiento endovascular de la estenosis de la arterial renal en el riñón trasplantado. Actas Urol Esp. 2012;36:325–9.</p>" ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 704 "Ancho" => 1642 "Tamanyo" => 119671 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Glomerular filtration and creatinine during the follow-up.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 937 "Ancho" => 1535 "Tamanyo" => 65075 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Direct and indirect DUS parameters during the follow-up.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 542 "Ancho" => 1500 "Tamanyo" => 114305 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Direct parameters: flow velocity at the site of stenosis and poststenosis flow velocity.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 639 "Ancho" => 1500 "Tamanyo" => 139160 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Indirect parameters: comparison of normal flow waves type I with waves type III (tardus-parvus).</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 638 "Ancho" => 951 "Tamanyo" => 95350 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Comparison of arterial diameters for aorta and iliac stent placement.</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 495 "Ancho" => 1750 "Tamanyo" => 141845 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Pretreatment arteriography, stent <span class="elsevierStyleItalic">in situ</span> and post-treatment.</p>" ] ] 6 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Degree of occlusion</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Location</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Length</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (31%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ostium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (61%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Annular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (31%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (31%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Juxta ostium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (31%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Short <0.5<span class="elsevierStyleHsp" style=""></span>cm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (54%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (38%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Middle third \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Long >0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (15%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab184214.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the stenoses treated.</p>" ] ] 7 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Pre PTAS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">3 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">12 months \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Creatinine (Mmol/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">357.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">176.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">169.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Glomerular filtration (ml/min) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab184213.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Mean of the clinical parameters assessed.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Longterm outcome of transplant renal artery stenosis managed conservatively or by radiological intervention" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.C. Geddesa" 1 => "S.K. McManusa" 2 => "S. Koteeswaranb" 3 => "G.M. Baxter" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Clin Transplant" "fecha" => "2008" "volumen" => "22" "paginaInicial" => "5728" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Angioplasty and stenting of arterial stenosis affecting renal transplant function" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Pappas" 1 => "G. Zavos" 2 => "S. Kaza" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Transplant Proc" "fecha" => "2008" "volumen" => "40" "paginaInicial" => "13916" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term follow-up of renal transplant patients with renal artery stenosis treated by percutaneous angioplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.H. Peregrin" 1 => "S.T. Jarmila" 2 => "J. 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Fernando" 1 => "M.D. Fervenza" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Am J Kidney Dis" "fecha" => "1998" "volumen" => "31" "paginaInicial" => "1428" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transplant renal artery stenosis: association with acute vascular rejection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.E. Fernández-Nájera" 1 => "S. Beltrán" 2 => "M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2018 February | 7 | 0 | 7 |
| 2018 January | 6 | 2 | 8 |
| 2017 December | 5 | 1 | 6 |
| 2017 November | 9 | 2 | 11 |
| 2017 October | 11 | 3 | 14 |
| 2017 September | 11 | 2 | 13 |
| 2017 August | 22 | 3 | 25 |
| 2017 July | 26 | 1 | 27 |
| 2017 June | 20 | 1 | 21 |
| 2017 May | 33 | 3 | 36 |
| 2017 April | 29 | 0 | 29 |
| 2017 March | 20 | 25 | 45 |
| 2017 February | 31 | 2 | 33 |
| 2017 January | 35 | 3 | 38 |
| 2016 December | 25 | 2 | 27 |
| 2016 November | 10 | 5 | 15 |
| 2016 October | 38 | 10 | 48 |
| 2016 September | 18 | 3 | 21 |
| 2016 August | 22 | 7 | 29 |
| 2016 July | 9 | 1 | 10 |
| 2016 June | 11 | 9 | 20 |
| 2016 May | 16 | 14 | 30 |
| 2016 April | 17 | 12 | 29 |
| 2016 March | 18 | 14 | 32 |
| 2016 February | 22 | 16 | 38 |
| 2016 January | 18 | 15 | 33 |
| 2015 December | 24 | 12 | 36 |
| 2015 November | 11 | 13 | 24 |
| 2015 October | 24 | 13 | 37 |
| 2015 September | 25 | 11 | 36 |
| 2015 August | 17 | 8 | 25 |
| 2015 July | 5 | 2 | 7 |
| 2015 June | 6 | 4 | 10 |
| 2015 May | 14 | 4 | 18 |
| 2015 April | 49 | 6 | 55 |
| 2015 March | 16 | 9 | 25 |
| 2015 February | 18 | 1 | 19 |
| 2015 January | 32 | 10 | 42 |
| 2014 December | 32 | 11 | 43 |
| 2014 November | 22 | 4 | 26 |
| 2014 October | 35 | 9 | 44 |
| 2014 September | 43 | 5 | 48 |
| 2014 August | 38 | 6 | 44 |
| 2014 July | 28 | 4 | 32 |
| 2014 June | 20 | 4 | 24 |
| 2014 May | 27 | 6 | 33 |
| 2014 January | 5 | 1 | 6 |
| 2013 December | 15 | 3 | 18 |
| 2013 November | 16 | 3 | 19 |
| 2013 October | 10 | 4 | 14 |
| 2013 September | 9 | 2 | 11 |
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