Zero-contrast PTRA and stenting for child with TRAS: A case report

Area of Science:

• Nephrology
• Interventional Cardiology
• Radiology

Background:

• Transplant-associated renal artery stenosis (TRAS) is a common complication post-kidney transplant.
• Percutaneous transluminal renal angioplasty (PTRA) is effective for TRAS but limited in patients with chronic kidney disease (CKD) due to contrast-induced nephropathy.

Observation:

• A 14-year-old kidney transplant recipient with RAS initially underwent balloon dilation.
• One and a half years later, the patient received zero-contrast PTRA and stenting.
• Guidance was provided by external ultrasound and intravascular ultrasound (IVUS), referencing a prior peripheral angiography (PAG) image.

Findings:

• Successful stent implantation significantly increased the renal artery lumen's cross-sectional area.
• Post-procedure, blood pressure and serum creatinine levels decreased and remained stable during follow-up.

Implications:

• Zero-contrast PTRA guided by external ultrasound and IVUS is a feasible alternative for TRAS patients with compromised renal function or contrast allergies.
• This technique offers a safer treatment option, mitigating risks associated with iodinated contrast agents in vulnerable populations.