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Renal artery stenosis is the most frequent vascular complication after renal transplantation that occurs in 1% to 23% of post-transplant patients and that occurs between 3 months to 2 years after renal transplantation, being the most common at 6 months and increases graft loss and mortality of patients.
26-year-old female patient with 3 years of diagnosis of chronic kidney disease who received renal transplantation from a live-related donor on May 18, 2023, with a hot ischemia time of 5 minutes and 12 seconds, cold ischemia of 50 minutes with final anastomosis renal artery terminal, in the post-operative presented high levels of blood pressure (170/100 mmHg) difficult to manage and that required the use of triple therapy for management, IR 0.47 and parvus tardus wave and PS 94 cm/s (Figure 1) renal angiotomography showing renal artery stenosis at the site of anastomosis, with a percentage of 78% stenosis (Figure 2) patient with creatinine in decline at that time in 1.11 so the patient is left with supportive treatment (antihypertensive) and surveillance and Doppler control and tomographic study is decided in 3 months, which is performed on August 15, 2023, in which IR <0.5 with PS is evidenced in 491.7 cm/s, (Figure 3) and persistence of renal artery stenosis with 85% of stenosis, (Figure 4) case is presented to Interventional Cardiology and on August 31, 2023 it was decided to take the patient to angioplasty, in which stent is placed to stenosis with balloon of 0.8 for correction of the same (Figure 5 and 6) and the lumen is restored and with ultrasound control Doppler with IR in 0.67 and PS in 124 cm/s (Figure 7) after correction procedure, also patient with creatinine in 1.3 with adequate urinary excretion and removal of antihypertensive drugs.
In the literature it is known that renal artery stenosis is the most frequent vascular complication although other vascular complications have been found, according to the site and the time of presentation can be suspected various causes among which are considered surgical techniques and lesions to vessels during the extraction and implant of the graft, and in terminal anastomosisterminals in which it is usually more common that can be considered a cause in the patient we present, patient at the beginning with PS who was less than 200 cm/s so conservative management was decided as the guidelines indicate but then presented PS >400 cm/s still with dependence on antihypertensive drugs so angioplasty was performed with which there was significant improvement in patient case, as the literature also indicates in other cases, since if not corrected the loss of graft increases by 2.8 times the risk and increase of 2.4 times the mortality of the patient.
It is important to recognize and prevent this pathology in patients who receive a renal transplant associated with risk factors prior to transplantation, during the explant and the implant of the graft and that in turn according to clinical characteristics of the patient an intervention should be made according to clinical characteristics of each patient to improve the long-term survival of the graft