Published online Oct 22, 2018. doi: 10.5500/wjt.v8.i6.232
Peer-review started: March 11, 2018
First decision: March 30, 2018
Revised: April 28, 2018
Accepted: October 8, 2018
Article in press: October 8, 2018
Published online: October 22, 2018
A 38-year-old male, who had received a deceased donor renal transplant presented with deterioration of renal function five months post-transplantation.
On examination, there were clinical features pointing to definitive diagnosis.
Differential diagnosis included obstructive uropathy, acute rejection, infections, drug nephrotoxicity and transplant renal artery stenosis.
The serum creatinine was significantly elevated.
The Duplex ultrasound scan showed reduced resistive index with high velocity flow in the renal artery suggestive of transplant renal artery stenosis. A computerized tomography angiogram showed a 20 mm × 25 mm pseudoaneurysm at the anastomosis site and stenosis of the transplant renal artery adjacent to the pseudoaneurysm.
Endovascular embolisation of the pseudoaneurysm using expandable hydrogel coils (EHC) followed by deployment of stent lead to resolution of the pseudoaneurysm and transplant renal artery stenosis and restoration of renal function to normality.
Follow-up of the patient was satisfactory with no adverse events related to the procedure.
This is the first reported case of treatment of a transplant renal artery pseudoaneurysm with wide neck with the use of EHC leading to successful outcomes.