2025 Volume 54 Issue 5 Pages 247-250
Iliac artery stenosis associated with atherosclerosis after renal transplantation affects transplanted kidney function and graft kidney engraftment rate. We report a case of iliac artery revascularization for arteriosclerotic obliterans that improved renovascular hypertension and renal dysfunction. A 58-year-old male underwent a living donor renal transplant 20 years ago. He had experienced intermittent claudication in his right lower limb for 3 years. Computed tomography (CT) revealed severe stenosis of the right common iliac and femoral arteries because of a highly calcified plaque. The transplanted renal artery was anastomosed to the right external iliac artery. On admission, the patient had marked hypertension despite taking antihypertensive medication, and his plasma renin concentration was elevated to 126 pg/ml. Retrospectively, his serum creatinine concentration had increased from about one year earlier. Thus, the patient was diagnosed with renovascular hypertension and transplanted kidney dysfunction owing to reduced graft blood flow caused by proximal arterial stenosis. The patient underwent right common femoral artery thromboendarterectomy and endovascular treatment of both common iliac arteries resulting in a reduction in serum creatinine and plasma renin concentrations and blood pressure, in addition to an improvement in intermittent claudication. We hypothesized that iliac artery stenosis is an infrequent but important postoperative complication that should be considered when graft blood flow is suspected to decrease after kidney transplantation.
