SONOWORLD : Occluded upper pole branch of the transplant renal artery

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Vascular » Visceral vascular

Occluded upper pole branch of the transplant renal artery

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Author(s) :

Chaitali Shah, FRCR

Presentation A 35 year old patient, 24 hours status post renal transplant, presents with pain at the site of renal transplant. An ultrasound was performed.

Caption: Sagittal view of transplant kidney-lower pole

Description: Normal arterial flow to the lower pole of the kidney is noted.

Caption: Sagittal view of transplant kidney-upper pole

Description: Decreased to almost absent flow is noted in the upper pole of the kidney.

Caption: Spectral waveform analysis of lower pole renal artery

Description: A normal resistive index of 0.7 was noted in the lower pole renal artery.

Caption: Spectral waveform analysis of upper pole artery

Description: Diminished flow is noted here with a high resistive index of 1.0.

Differential Diagnosis Occlusion of the renal arterial branch supplying the upper pole of the renal transplant

Final Diagnosis Occlusion of the allograft renal arterial branch supplying the upper pole of the renal transplant

Discussion Occlusion of the main or branch of the allograft renal artery can occur as a vascular complication following renal transplantation. The incidence of allograft renal artery thrombosis varies from 1.4 to 3.5%.
Aggressive surgical approach to restoring circulation is indicated in order to prevent transplant rejection.

Case References 1. Jordan ML, Cook GT, Cardella CJ. Ten years of experience with vascular complications in renal transplantation. J Urol. 1982 Oct; 128(4):689-92.
2. Rathod J, Upadhayay D, Modhe J, Sirsat R. Restoration of renal function after prolonged allograft artery occlusion by thrombolysis. Nephrol Dial Transplant (2000) 15: 287-288.
3. Melzer JS, Sicard GA, Etheredge EE, Anderson CB. Successful revascularization of early posttransplant renal arterial occlusion. Surgery. 1982 Feb; 91(2):168-72.