PMC4555357_01
Retrograde pyelography of the kidney allograft showing patency of the ureter, pelvis, and calyces (a). Preprocedural color Doppler of kidney allograft showing renal arterial flow reversal during diastolic phase (b), with normalization of arterial flow pattern on day 1 after the intervention (c).
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The urology service was initially consulted, and the patient underwent a cystoscopy with retrograde ureterogram, which revealed normal iodinated contrast filling and caliber of the ureter and intrarenal collective system of the kidney allograft (Figure 1(a)). The study demonstrated reversal of flow within multiple renal arterial branches during diastole (Figure 1(b)), which was suspicious for either arterial or venous occlusive disease.
Aortoiliac and femoral angiogram showing complete occlusion (red arrow) of the right common iliac artery proximal to the kidney allograft anastomosis (a). Collaterals from the left iliac and femoral arteries feeding right-sided vessels below the occlusion (b). Balloon angioplasty of the right common iliac artery (c). Partial recanalization and visible floating thrombus (black arrow) of the right common iliac artery after balloon angioplasty (d). Balloon assisted covered stent (iCast) deployment and postdilation of the stent (e). Postintervention angiogram shows normal flow to the kidney allograft (f).
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Iliac angiography revealed a thrombus obstructing 99% of the proximal right common iliac artery (Figure 2(a)).