Arteriography of renal transplantation

The arterial anatomy of renal transplants is often complex, with overlapping, tortuous vessels which prevent easy visualisation of the origins of the transplant artery. We have adopted a technique using smallbore catheters with non-selective 'flush' injections of contrast medium, high resolution magnification techniques and multiple oblique projections. A retrospective study over six years (1980 to 1985 inclusive) revealed 34 significant (greater than 50%) transplant artery stenoses (13 adults, 21 children) from 200 transplant arteriograms performed. During this period, 452 transplants were performed, 38% in children. The incidence of transplant artery stenosis was 7.5%. Percutaneous transluminal angioplasty was attempted in 11 patients (four adults, seven children), with technical success in only five (45.5%). The predominance of children in this group contributes to the poor success rate of percutaneous transluminal angioplasty in our hands, which we attribute to the small arteries involved, the acute vessel angulations seen and the tough undilatable stenoses which are encountered in transplants in paediatric patients. Fourteen patients with post biopsy arterio-venous fistulae are described and the role of embolisation in this condition is discussed. A simplified approach for the arteriography of live related donors is also described.