ILIAC ARTERY-STENOSIS AFTER KIDNEY-TRANSPLANTATION

In human kidney transplantation hypertension and renal dysfunction are common complications. Diagnosis of vascular involvement may frequentl y be necessary. Although iliac artery stenosis is a rare complication after renal transplantation, it can be the cause of hypertension and r enal dysfunction. Because colour duplex scanning is a repeatable non-i nvasive technique, it may provide a useful tool in establishing a diag nosis of iliac artery stenosis in patients with hypertension and/or re nal dysfunction. We present four cases of iliac artery stenosis in kid ney allograft recipients. Colour duplex scanning was used in these pat ients to detect and localize the stenosis. Quantitative analysis of Do ppler spectra was used to compare the Doppler spectrum waveforms obtai ned from both femoral arteries and from the kidney allograft arteries of these patients with the normal range. This normal range was determi ned from Doppler spectra obtained in a control group of 21 kidney allo graft recipients. Clinical data, arterial DSA, and the outcome of trea tment were used to validate colour duplex findings in the patients wit h iliac artery stenosis. Quantitative analysis of Doppler spectra show ed differences between the femoral artery on the affected side and the contralateral side outside the normal range. In three patients the il iac artery stenosis was located proximal from the anastomosis with the kidney allograft artery and in these three patients Doppler parameter s obtained from the allograft artery were also outside the normal rang e. In one patient the stenosis was located distally from the anastomos is with the kidney allograft artery. In this case Doppler spectra from the kidney allograft artery were within the normal range. In two pati ents the clinical course neccessitated correction of the stenosis. Ren al function and Doppler spectra from the arteries normalized after cor rection. In conclusion, comprehensive use of colour duplex scanning wi th quantitative analysis of Doppler spectra enables accurate non-invas ive diagnosis and localization of iliac artery stenoses in kidney allo graft recipients and facilitates selection of the appropriate clinical approach.