status post living related donor kidney transplant to the left iliac fossa in February 2001 who had progressive increased creatinine, worsening hypertension and recent renal ultrasound demonstrating high velocities at the anastomosis as well as increased
resistive index in the intrarenal arteries. Patient is not a candidate for magnetic resonance angiography due to the aortic valve replacement and has been on chronic Coumadin. The patient is referred for renal arteriogram and possible angioplasty.
Contrast angiography with dilute contrast demonstrates a high-grade anastomotic stenosis at the origin of the renal artery extending for approximately 1cm. The renal transplant artery has a relatively acute
upward course from its takeoff from the external iliac artery. There is also eccentric narrowing of the external iliac artery immediately adjacent to the
renal transplant origin.
At angioplasty there is easy dilation of the balloon with an elastic character to the stenosis. Images following angioplasty demonstrate a mildly
improved lumen with residual stenosis of approximately 50%. Pressure measurements after angioplasty demonstrate pressure of 144/80 in the renal
artery and 176/86 in the external iliac artery, giving a gradient of 32mmHg.
Transplant Renal Artery Stenosis
Dx: Transplant Renal Artery Stenosis seen on angiogram
Dx Confirmed by:
After administration of heparin and nitroglycerine,
a guidewire was advanced into the intrarenal artery and angioplasty performed with a 4mmx20mm angioplasty balloon.
There is mild to moderate improvement in the high-grade stenosis after angioplasty to 4mm; however, the stenosis is elastic with a significant extrinsic component suggested. The residual gradient suggests that this is still hemodynamically significant. Options for treatment would include transplant artery anastomotic revision vs. stent placement. The latter has a lower patency in relatively small sized renal arteries.
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