Kosin Med J.  2019 Dec;34(2):168-172. 10.7180/kmj.2019.34.2.168.

Aortoiliac Occlusive Disease as a Cause of Allograft Kidney Dysfunction and Refractory Hypertension

Affiliations
  • 1Department of surgery, Seoul Paik hospital, Inje University, Korea. Jin.theDoc@gmail.com

Abstract

Aortoiliac occlusive disease (AIOD), especially proximal to the transplant artery, in kidney transplant patient activates the renin-angiotensin-aldosterone system by limiting graft renal perfusion and causes symptoms that can occur with transplant renal artery stenosis (TRAS) such as refractory hypertension, water retention, and graft renal dysfunction. Immediate clinical suspicion is difficult due to the nature of the progressive disease unlike TRAS. Herein, we present an interesting case of bilateral common iliac artery occlusion (AIOD, TASC II, type C) that manifested as uncontrolled blood pressure and decreased allograft function in a patient who had kidney transplant 17 years ago. The patient was successfully diagnosed with duplex scan, ankle-brachial index (ABI) and computed tomography angiography and treated with percutaneous luminal angioplasty and stent graft insertion.

Keyword

Allograft dysfunction; Common iliac artery; Kidney transplantation; Refractory hypertension

MeSH Terms

Allografts*
Angiography
Angioplasty
Ankle Brachial Index
Arteries
Blood Pressure
Blood Vessel Prosthesis
Humans
Hypertension*
Iliac Artery
Kidney Transplantation
Kidney*
Perfusion
Phenobarbital
Renal Artery Obstruction
Renin-Angiotensin System
Transplants
Water
Phenobarbital
Water

Figure

  • Fig. 1 Duplex ultrasonography showing (A) normal size and echogenicity of graft kidney and (B) low resistive index and pulsus parvus et tardus pattern in the intrarenal artery

  • Fig. 2 Non-contrast-enhanced Computed Tomography angiography showing heavily calcified chronic total occlusion of both common iliac artery (white arrows). (A)axial scan and (B)coronal scan

  • Fig. 3 Completing angiography showing successful deployment of stent grafts in both common iliac artery occlusions without graft kidney thromboembolism

  • Fig. 4 Follow-up Duplex ultrasonography showing normal resitive index and flow pattern in intrarenal artery


Reference

1. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007; 33:Suppl 1. S5–75.
Article
2. Bracale UM, Giribono AM, Spinelli D, Del Guercio L, Pipitò N, Ferrara D, et al. Long-term Results of Endovascular Treatment of TASC C and D Aortoiliac Occlusive Disease with Expanded Polytetrafluoroethylene Stent Graft. Ann Vasc Surg. 2019; 56:254–260.
Article
3. Mwipatayi BP, Sharma S, Daneshmand A, Thomase SD, Vijayan V, Altaf N, et al. Durability of the balloon-expandable covered versus bare-metal stents in the Covered versus Balloon Expandable Stent Trial (COBEST) for the treatment of aortoiliac occlusive disease. J Vasc Surg. 2016; 64:83–94.e1.
Article
4. Bruno S, Remuzzi G, Ruggenenti P. Transplant renal artery stenosis. J Am Soc Nephrol. 2004; 15:134–141.
Article
5. Coemans M, Süsal C, Döhler B, Anglicheau D, Giral M, Bestard O, et al. Analyses of the short- and long-term graft survival after kidney transplantation in Europe between 1986 and 2015. Kidney Int. 2018; 94:964–973.
Article
6. Becker BN, Odorico JS, Becker YT, Leverson G, McDermott JC, Grist T, et al. Peripheral vascular disease and renal transplant artery stenosis: a reappraisal of transplant renovascular disease. Clin Transplant. 1999; 13:349–355.
Article
7. Voiculescu A, Hollenbeck M, Plum J, Hetzel GR, Mödder U, Pfeiffer T, et al. Iliac artery stenosis proximal to a kidney transplant: clinical findings, duplex-sonographic criteria, treatment, and outcome. Transplantation. 2003; 76:332–339.
Article
8. Misra S, Shishehbor MH, Takahashi EA, Aronow HD, Brewster LP, Bunte MC, et al. Perfusion Assessment in Critical Limb Ischemia: Principles for Understanding and the Development of Evidence and Evaluation of Devices: A Scientific Statement From the American Heart Association. Circulation. 2019; 140:e657–e672.
Article
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