Dr Himanshu Pendse1, Dr Gregory Vanschie1, Dr Hemant Kulkarni1
1Royal Perth Hospital, , Australia
Biography:
I am an Interventional Radiologist working at Royal Perth Hospital, Perth. I am done my IR training at Sir Charles Gardiner Hospital. I have keen interest in Interventional procedures.
Abstract:
Post-renal transplant hypertension is a common complication, with vascular aetiologies contributing to a minority of cases. While transplant renal artery stenosis (TRAS) at the anastomosis or main renal artery is a well-recognized cause, other vascular obstructions, such as iliac artery dissection, can be overlooked. This case report highlights the successful endovascular management of iliac artery dissection as a previously unrecognized cause of persistent post-renal transplant hypertension.
Procedure:
Digital subtraction angiography (DSA) confirmed the presence of parallel dissection flaps within the right external iliac artery, as observed on CT angiography. Despite apparent vessel patency, a significant pressure gradient (approximately 20 mmHg) was measured between the proximal and distal segments of the dissected artery, indicating hemodynamic compramise.
Endovascular intervention via left common femoral artery access deployed a 6 x 29 mm self-expanding stent across the dissected segment, resulting in immediate resolution of the pressure gradient (Figure 1).
Outcome:
The pre-stenting blood pressure was systolic 180 mm Hg and diastolic 86 mm Hg on four anti-hypertensives on maximum dose. At 2-month follow-up, the patient demonstrated improved blood pressure control (systolic 134 mm Hg and diastolic 73 mm Hg) with progressive reduction in antihypertensive medication requirements.
The pre-stenting eGFR ranged from 59-65 ml/min/1.73 m2 to more than 90 at 2 month follow-up indicating improvement in graft function.