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.
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.