EURORAD ESR

Case 15001

Transplant Renal Artery Stenosis – Percutaneous Transluminal Angioplasty and Stenting

Author(s)
Almeida Costa, Nuno1; Oliveira, João André2; Veloso Gomes, Filipe3; Bilhim, Tiago3; Coimbra, Élia3.

1 Instituto Português de Oncologia do Porto de Francisco Gentil, IPO - Porto
Rua Dr. António Bernardino de Almeida 4200-072 Porto, Portugal.
Email:nunoada@hotmail.com

2 Centro Hospitalar do Porto – Hospital de Santo António
Largo Prof. Abel Salazar 4099-001 Porto, Portugal.
Email: joao_a_oliveira@hotmail.com

3 Centro Hospitalar de Lisboa Central – Hospital Curry Cabral
R. Beneficência 8, 1050-099 Lisboa, Portugal.
Email: fvgomes@gmail.com ; tiagobilhim@hotmail.com ; elia.coimbra@gmail.com
 
Patient
male, 62 year(s)
 
 
  • Figure 1
    Renal graft B mode Doppler evaluation demonstrating normal corticomedullary differentiation

    B mode Doppler ultrasound evaluation of the renal transplant in the right iliac fossa demonstrating normal corticomedullary differentiation of the renal parenchyma. There are no perinephric fluid collections.

     
    Area of Interest: Kidney; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Grafts;
     
     
  • Figure 2
    Tardus and parvus waveform of the transplant interlobar arteries

    Spectral and color Doppler evaluation showing interlobar transplant arteries with a low resistive index (0,5) and a tardus and parvus waveform.

     
    Area of Interest: Kidney; Imaging Technique: Ultrasound-Spectral Doppler; Procedure: Diagnostic procedure; Special Focus: Grafts;
     
     
  • Figure 3
    Spectral Doppler suggesting TRAS (transplant renal artery stenosis)

    Spectral Doppler evaluation showing markedly increase in flow velocity (>200cm/sec) at the origin of the transplant renal artery (post-anastomotic) suggesting TRAS.

     
    Area of Interest: Kidney; Imaging Technique: Ultrasound-Spectral Doppler; Procedure: Diagnostic procedure; Special Focus: Grafts;
     
     
  • Figure 4
    Angiogram evaluation confirming TRAS

    Non-selective right iliac angiogram confirms a significant focal tight stenosis at anastomotic site. It also excludes iliac stenosis and helps determining orientation.

     
    Area of Interest: Interventional vascular; Imaging Technique: Catheter arteriography; Procedure: Arterial access; Special Focus: Grafts;
     
     
  • Figure 5
    Angioplasty with primary stenting

    Fluoroscopic evaluation after angioplasty with primary stenting. A balloon-expandable 5 mm x 20mm stent was deployed in the stenosis and anastomotic region. Note the regular and adequate stent luminal diameter.

     
    Area of Interest: Interventional vascular; Imaging Technique: Fluoroscopy; Procedure: Stents; Special Focus: Grafts;
     
     
  • Figure 6
    Post-procedure angiogram demonstrating stenting technical sucess

    Post-procedure angiogram demonstrating patency of the transplant artery after percutaneous transluminal angioplasty and stenting with satisfactory diameter.

     
    Area of Interest: Interventional vascular; Imaging Technique: Catheter arteriography; Procedure: Stents; Special Focus: Grafts;
     
     
  • Figure 7
    Post procedure Doppler evaluation showing normal intra-stent flow velocity

    Spectral and color Doppler follow-up examination performed two days after the procedure showing patency of the transplant artery with normal flow velocity (71cm/sec) inside the stent in the anastomotic region.

     
    Area of Interest: Interventional vascular; Imaging Technique: Ultrasound-Spectral Doppler; Procedure: Stents; Special Focus: Grafts;
     
     
  • Figure 8
    Post procedure Doppler evaluation showing normal interlobar arteries waveform

    Spectral and color Doppler follow-up examination performed two days after the procedure showing normal interlobar arteries waveform with adequate resistive index of 0,74.

     
    Area of Interest: Interventional vascular; Imaging Technique: Ultrasound-Spectral Doppler; Procedure: Stents; Special Focus: Grafts;
     
     
B mode Doppler ultrasound evaluation of the renal transplant in the right iliac fossa demonstrating normal corticomedullary differentiation of the renal parenchyma. There are no perinephric fluid collections.
 
Spectral and color Doppler evaluation showing interlobar transplant arteries with a low resistive index (0,5) and a tardus and parvus waveform.
 
Spectral Doppler evaluation showing markedly increase in flow velocity (>200cm/sec) at the origin of the transplant renal artery (post-anastomotic) suggesting TRAS.
 
Non-selective right iliac angiogram confirms a significant focal tight stenosis at anastomotic site. It also excludes iliac stenosis and helps determining orientation.
 
Fluoroscopic evaluation after angioplasty with primary stenting. A balloon-expandable 5 mm x 20mm stent was deployed in the stenosis and anastomotic region. Note the regular and adequate stent luminal diameter.
 
Post-procedure angiogram demonstrating patency of the transplant artery after percutaneous transluminal angioplasty and stenting with satisfactory diameter.
 
Spectral and color Doppler follow-up examination performed two days after the procedure showing patency of the transplant artery with normal flow velocity (71cm/sec) inside the stent in the anastomotic region.
 
Spectral and color Doppler follow-up examination performed two days after the procedure showing normal interlobar arteries waveform with adequate resistive index of 0,74.
 
 
 
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