AUTHOR=Vu Vu Hoang , Nguyen Nghia Thuong , Nguyen Chinh Duc , Nguyen Khang Duong , Truong Binh Quang 

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

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 11 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1396998

DOI=10.3389/fcvm.2024.1396998

ISSN=2297-055X

ABSTRACT=Background: Transplant renal artery dissection 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 transplant renal artery dissection in the early post-operative period, which was successfully managed with intravascular ultrasound assisted endovascular intervention.Case presentation: A 38-year-old man underwent HLA-compatible living kidney transplantation. The allograft had one renal artery and vein that were anastomosed to the internal iliac artery and external iliac vein, respectively. Doppler ultrasonography performed a day after operation showed an increase in the systolic blood velocity and urine output was not observed. Arterial anastomotic stenosis was suspected.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 stent. After the intervention, Doppler US revealed that 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 Conclusions: Transplant 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 complication such as dissection and help patient avoid high risk operation. Early diagnosis and IVUS assisted intervention with experienced interventionist can save allograft dysfunction.