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Early Posttransplantation Renal Allograft Perfusion Failure Due to Dissection: Diagnosis and Interventional Treatment

Masahide Takahashi1,2, Ulrich Humke3, Matthias Girndt4, Bernhard Kramann1 and Michael Uder1

1 Department of Diagnostic Radiology, The Saarland University Hospital, Kirrberger Str. 1, D-66421 Homburg (Saar), Germany.
2 Present address: Department of Radiology, Tsukuba-Gakuen Hospital, 2573-1 Kamiyokoba, Tsukuba, Ibaraki 305-0854, Japan.
3 Department of Urology, Julius-Maximilians University, Josef-Schneider Str. 2, D-97080 Wuerzburg, Germany.
4 Department of Nephrology, The Saarland University Hospital, D-66421 Homburg (Saar), Germany.



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  		Fig. 1A. —76-year-old man with intimal dissection of renal allograft artery on day 2 after transplantation. Right iliac arteriogram obtained with contralateral approach shows intimal flap (arrows) severely narrowing graft artery.

 


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  		Fig. 1B. —76-year-old man with intimal dissection of renal allograft artery on day 2 after transplantation. Arteriogram shows that after stent angioplasty with ipsilateral approach, complete repair of dissection is seen.

 


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  		Fig. 2A. —60-year-old man with intimal dissection of renal allograft artery and graft venous thrombosis on day 7 after transplantation. Right external iliac arteriogram obtained through ipsilateral vascular sheath shows short-segment intimal flap (arrow) at proximal portion of graft artery with approximately 50% stenosis.

 


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  		Fig. 2B. —60-year-old man with intimal dissection of renal allograft artery and graft venous thrombosis on day 7 after transplantation. Arteriorgram shows that after percutaneous transluminal angioplasty, persistent flap and stenosis are seen.

 


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  		Fig. 2C. —60-year-old man with intimal dissection of renal allograft artery and graft venous thrombosis on day 7 after transplantation. Arteriorgram shows that after stent placement, no residual stenosis is present.

 


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  		Fig. 2D. —60-year-old man with intimal dissection of renal allograft artery and graft venous thrombosis on day 7 after transplantation. Venous phase of selective allograft arteriogram shows prolonged parenchymal stain and outflow stenosis (arrow).

 


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  		Fig. 2E. —60-year-old man with intimal dissection of renal allograft artery and graft venous thrombosis on day 7 after transplantation. Direct venogram of graft vein shows multiple thrombi in renal and iliac veins.

 


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  		Fig. 2F. —60-year-old man with intimal dissection of renal allograft artery and graft venous thrombosis on day 7 after transplantation. Direct venogram of graft vein shows that after thromboaspiration, venous outflow is almost cleared of thrombus. Some small thrombi may remain.

 


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  		Fig. 3A. —58-year-old man with intimal dissection of renal allograft and extensive renal infarction on day 3 after transplantation. Right external iliac arteriogram obtained through ipsilateral vascular sheath shows graft artery with severe stricture (arrow). Note extensive atherosclerosis of iliac arteries and total occlusion of internal iliac artery (arrowhead).

 


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  		Fig. 3B. —58-year-old man with intimal dissection of renal allograft and extensive renal infarction on day 3 after transplantation. Later phase of right external iliac arteriogram (A) shows significantly diminished graft perfusion.

 


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  		Fig. 3C. —58-year-old man with intimal dissection of renal allograft and extensive renal infarction on day 3 after transplantation. Selective allograft arteriogram obtained through guiding catheter after percutaneous transluminal angioplasty shows flat filling defect at origin of renal artery.

 


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  		Fig. 3D. —58-year-old man with intimal dissection of renal allograft and extensive renal infarction on day 3 after transplantation. Selective allograft arteriogram obtained through guiding catheter after first stent placement shows remaining intimal flap (arrow).

 


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  		Fig. 3E. —58-year-old man with intimal dissection of renal allograft and extensive renal infarction on day 3 after transplantation. Selective allograft arteriogram obtained through guiding catheter after second (distal) stent placement shows no residual stenosis.

 

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