CASE 2447 Published on 25.11.2003

Common iliac artery PTA in the kidney transplant

Section

Interventional radiology

Case Type

Clinical Cases

Authors

Krajíčková D, Peregrin J, Vítko Š

Patient

36 years, male

Clinical History
The patient was admitted to angiography four years after a kidney transplantation suffering of secondary arterial hypertension, caused probably by stenosis of the graft or other feeding arteries.
Imaging Findings
The patient had congenital kidney hydronephrosis and right nephrectomy at the age of one. There was chronic pyelonephritis in the solitary left kidney. Regular hemodialysis was started in January 1998 (age 31 years). A living donor kidney transplantation was performed in late 1998. Function was stable with Cr around 180 mmol/l and chronic sclerosing nephropathy. Regular follow-up by duplex ultrasound led to a suspicion of stenosis of the anastomosis of the graft or adjacent vessels. Angiography, using non-ionic contrast media, revealed a normal graft artery, but significant stenosis of the common iliac artery. In the same session, we performed a successful percutaneous transluminal angioplasty (PTA) of this lesion with a balloon expandable metallic stent measuring 9mm x 37mm (Express Vascular LD, Boston Scientific), (Fig.1). Six months later, the patient had a claudication interval 50 meters in the left leg. This time, coronary angiography (for chest pain) was performed with left leg angiography. This was followed by PTA of the left common iliac artery (Fig.2) and coronary artery bypass surgery of six vessels.
Discussion
In adults, anastomosis of the kidney transplant artery will typically occur on the external iliac artery. Stenosis of the graft anastomosis is a complication experienced by approximately 5-15 % patients and can be treated by PTA and stent or (in cases of tortuous vessels) by surgery. Duplex sonography can be very useful in the detection of graft malfunctioning and/or graft artery stenosis, but angiography is still the gold standard in the detection of arterial stenosis. Magnetic Resonance Angiography (MRA) or carbon dioxide angiography are useful in cases will elevated serum creatinine levels. In our case, although the patient did not complain of claudications, angiography revealed a common iliac artery stenosis. Early treatment of this condition by PTA and stent was necessary for the salvation of a well-functioning kidney and stabilization of hypertension.
Differential Diagnosis List
Common iliac artery stenosis in a kidney transplant
Final Diagnosis
Common iliac artery stenosis in a kidney transplant
Case information
URL: https://www.eurorad.org/case/2447
DOI: 10.1594/EURORAD/CASE.2447
ISSN: 1563-4086