URINARY Section 7: Transplant Vascular complications

Question 1

Doppler: Absent or almost totally absent cortical flow in the kidney (color or power Doppler)

Answer 1

Renal Allograft Compartment Syndrome (RACS)

Question 2

Seen immediately - usually < 2 hours post transplantation

Answer 2

Renal Allograft Compartment Syndrome (RACS)

Question 3

This is usually an operative complication where the kidney was too big for the pelvic extraperitoneal space they decided to jam it and when they stitch the fascia back up it puts the squeeze on the kidney. You can imagine if there was a fluid collection nearby that would make it worse

Answer 3

Renal Allograft Compartment Syndrome (RACS)

Question 4

Seen immediately - usually < 2 hours post transplantation

Answer 4

Renal Allograft Compartment Syndrome (RACS)

Question 5

is the main risk factor associated with RACS.

Answer 5

Large transplanted kidney (Transplant size matters)

Question 6

Usually very early (mins to hours) as a post op complication (clamp injury etc…)

Answer 6

Renal Artery Thrombosis

Question 7

Doppler: Flow is gone

Answer 7

Renal Artery Thrombosis

Question 8

Grey Scale: Might see wedge shaped hypoechoic infarcts

Answer 8

Renal Artery Thrombosis

Question 9

Depending on who you ask - like 30% of kids have graft failure because of this…

Answer 9

Renal Vein Thrombosis

Question 10

Usually the first 5 days (peak at 48 hours)

Answer 10

Renal Vein Thrombosis

Question 11

Doppler: Flow in the vein is gone. Reversed diastolic arterial flow.

Answer 11

Renal Vein Thrombosis

Question 12

Grey Scale: Swollen / enlarged kidney.

Answer 12

Renal Vein Thrombosis

Question 13

3 months - Two Years

Answer 13

Renal Artery Stenosis (RAS)

Question 14

this is the most common vascular complication in a transplant.

Answer 14

Renal Artery Stenosis (RAS)

Question 15

“hvpertension refractor/ to treatment”

Answer 15

Renal Artery Stenosis (RAS)

Question 16

Doppler: PSV > 250 cm/s
or 1.8-2.5x increase from the “normal” vessel.

Answer 16

Renal Artery Stenosis (RAS)

Question 17

Feeding artery with a high velocity low- resistance waveform

Answer 17

AV Fistula

Question 18

Vein with a turbulent arterial appearance.

Answer 18

AV Fistula

Question 19

Tissue Vibration Artifact

Answer 19

AV Fistula

Question 20

Usually - no clinically significant hemodynamic consequence and no intervention needed

Answer 20

AV Fistula

Question 21

To-and-Fro pattern of blood flow within the neck

Answer 21

Pseudoaneurysm

Question 22

Yin-yang sign of swirling blood within the sac

Answer 22

Pseudoaneurysm

Question 23

Often need an intervention - especially if large (historically > 2 cm) or increasing in size

Answer 23

Pseudoaneurysm

Question 24

This can occur after biopsy or from blunt trauma.

Answer 24

Traumatic Hematoma

Question 25

Transplant kidneys don’t have ribs and are fairly superficial - so they can get banged up in minor trauma.

Answer 25

Traumatic Hematoma

Question 26

Complex Collection

Answer 26

Traumatic Hematoma

Question 27

Heterogenous, Septa, Etc…

Answer 27

Traumatic Hematoma