Transplant Renal Artery Stenosis seen on angiogram

Clinical Presentation :: History and Physical Exam - Close/Open | Print -

Start

Here

Clinical Presentation: 46 y.o. patient

History

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.

Physical Examination and Laboratory

noncontributory

* MedPix Cases are provided for Education and are not a substitute for medical advice or consultation.

- First Image :: Image Inventory - (May Show Answer ...)

Click on Thumbnail Image for full-size picture. Inventory: || 4290

Renal transplant angiogram

Balloon placement/inflation

post 4-20 angioplasty

Case Summary - Slide Sorter

- Edit Captions

Image Findings

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.

Differential Diagnosis

Transplant Renal Artery Stenosis

Diagnosis

Transplant Renal Artery Stenosis seen on angiogram

Display Case Answer and Image Labels

:: Search Images for Transplant Renal Artery Stenosis seen on angiogram

Treatment and Followup

Tx and Followup:
After administration of heparin and nitroglycerine,
a guidewire was advanced into the intrarenal artery and angioplasty performed with a 4mmx20mm angioplasty balloon.

Additional Discussion:
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.

Topic Discussion

Diagnosis Topic Topic Details: :: :: Search for other Topics with

Highlight this =>[ ]<= for a Popup Search Tool

Dig Deeper ... for

Continuing Education: CME and CNE

This is not a "Case of the Week"

MedPix™ COW Cases are eligible for Category 1 CME and CNE

Contributor Credits

Submitted by: Thomas C Alewine -
Case/Image Editor: -

MedPix™ Sponsors

The MedPix™ Medical Image Teaching File Database and Atlas is sponsored by:
The Department of Radiology and Radiological Sciences
Uniformed Services University
Bethesda, Maryland 20814.

Printer Friendly Page -
Use this for Comments and Suggestions
MedPix® is a Registered Trademark of USUHS
The MedPix™ Database Engine is Patented - USPTO No. 7,080,098
Portions of MedPix™ are Copyright © 1999 - 2013 by J.G. Smirniotopoulos, M.D. & H. Irvine, M.D.
The MedPix™ Classification Schema Copyright © 1999 - 2013 by J.G.Smirniotopoulos,M.D.
MedPix™ has displayed more than 1,003,967,982 pages since 3 September 2000.
Successfully disconnected from database ... Google Analytics Active ... :: This is tf_case.html

-2 :: Case - 4290 :: - Transplant Renal Artery Stenosis seen on angiogramMedical Image Database, Atlas, and Teaching File All Cases are Peer Reviewed by an Editoral Panel

Clinical Presentation :: History and Physical Exam - Close/Open | Print -

Clinical Presentation: 46 y.o. patient

- First Image :: Image Inventory - (May Show Answer ...)

Dig Deeper ... for

-2 :: Case - 4290 :: - Transplant Renal Artery Stenosis seen on angiogram
Medical Image Database, Atlas, and Teaching File
All Cases are Peer Reviewed by an Editoral Panel