Vol. 7, Issue 2, Part B (2025)

Introduction: Transplant renal artery stenosis (TRAS) remains one of the most frequent vascular complications following renal transplantation, potentially leading to graft dysfunction and refractory hypertension. Endovascular therapy, particularly angioplasty with or without stenting, has become the preferred treatment due to its minimally invasive nature and high technical success rates.

Case Presentation: We report a 35-year-old male who underwent renal transplantation in June 2024 and presented to the interventional radiology department with progressively increasing antihypertensive requirements over three months. He had a history of transplant renal artery stenosis (TRAS) that had been treated with percutaneous balloon angioplasty three months after transplantation. The initial angioplasty resulted in symptomatic relief, with gradual tapering and discontinuation of all antihypertensive medications and normalization of renal Doppler parameters.

However, over the subsequent three months, the patient experienced a recurrence of hypertension, requiring escalation to four antihypertensive agents for adequate control.

Doppler ultrasonography revealed a peak systolic velocity (PSV) of 450 cm/s at the stenotic segment and a renal artery-to-aortic ratio exceeding 4, consistent with significant TRAS.

Intervention: Under general anesthesia, left common femoral artery access was achieved. Angiography demonstrated a tight ostial stenosis at the transplant renal artery with an acute anastomotic angle. After initial predilatation with a 4 × 8 mm balloon, a 4 × 9 mm drug-eluting stent was successfully deployed across the lesion. Post-stenting angiogram confirmed restoration of normal luminal diameter and flow.

Outcome: The patient’s blood pressure normalized post-procedure, allowing discontinuation of all antihypertensive medications. Post-stenting Doppler showed normalization of intrarenal waveforms.

Conclusion: Endovascular stent angioplasty offers a safe and effective modality for treating TRAS, ensuring prompt restoration of graft perfusion and blood pressure control while preserving graft function.