Percutaneous intervention of an iatrogenic transplant renal artery dissection causing early allograft dysfunction

Vijayvergiya, Rajesh; Sharma, Ashish; Kasinadhuni, Ganesh; Makkar, Kunaal; Shrimanth, Yamasandi S.

doi:10.4244/aij-d-22-00013

Cited by 1 publication

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“…As far as is currently understood, complications following renal transplantation are uncommon, with dissection of the graft renal artery being particularly rare. In the event that it does occur, balloon dilatation or surgery is the treatment of preference, which is usually performed after months of observation (5)(6)(7)(8). We documented a case in which the graft renal artery was dissected at an extremely early stage; stenting was effectively executed, yielding favorable results during the follow-up periods for both inpatients and outpatients.…”

Section: Discussionmentioning

confidence: 99%

Endovascular intervention with intravascular ultrasound guidance of very early dissection complication in transplant renal artery: a case report and literature review

Vu,

Nguyen,

Nguyen

et al. 2024

Front. Cardiovasc. Med.

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BackgroundTransplant renal artery dissection (TRAD) is a rare and serious event that can cause allograft dysfunction and eventually graft loss. Most cases are managed by operative repair. We report a case of TRAD in the early postoperative period, which was successfully managed with intravascular ultrasound-assisted endovascular intervention.Case presentationA 38-year-old man underwent HLA-compatible living kidney transplantation. The allograft had one renal artery and vein, which were anastomosed to the internal iliac artery and external iliac vein, respectively. Doppler ultrasonography performed a day after the operation showed an increase in systolic blood velocity, with no observed urine output and raising a suspicion of arterial anastomotic stenosis. Angiography showed a donor renal artery dissection distal to the moderately stenosed anastomosis site with calcified atherosclerotic plaque confirmed by IVUS. The transplant renal artery lesion was intervened with a stent. After the intervention, Doppler US revealed that the blood flow of the renal artery was adequate without an increase in the systolic blood velocity. Urine output gradually returned after 3 weeks, and serum creatinine level was normalized after 2 months.ConclusionsTransplant recipients commonly have atherosclerosis and hypertension, which are risk factors for arterial dissection. Our case showed that endovascular intervention can replace surgery to repair very early vascular complications such as dissection and help patients avoid high-risk operations. Early diagnosis and IVUS-assisted intervention with experienced interventionists can save allograft dysfunction.

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Section: Discussionmentioning

confidence: 99%