{"doi":"10.1016/j.jscai.2023.100802","title":"C-16 | Transplant Renal Artery Stenosis Causing Allograft Dysfunction Without Suitable Groin Access Site: An Operative Dilemma","abstract":"Transplant renal artery stenosis (TRAS) is a rare complication post kidney transplantation that can lead to refractory hypertension and allograft dysfunction. A patient with transplant kidney that had previously undergone kissing stents placement in the common/external iliac artery and internal iliac/transplant renal artery, underwent a Duplex ultrasound that showed >60% stenosis. The renal resistive indexes were normal (0.7). Due to the right common iliac-internal iliac artery stent configuration combined with the findings of left external iliac artery stent, left superficial femoral artery occlusion and severe left brachial artery stenosis, we elected right brachial artery access via cutdown. Selective angiography showed TRAS distally to previous IIA renal artery stent and proximally to the transplant renal artery bifurcation. Plain balloon angioplasty was performed, followed by a Zotarolimus eluted stent. Intravascular Ultrasound (IVUS) confirmed optimal stent apposition. Patient developed acute right-sided neurologic deficits, most likely attributed to the innominate-aortic arch crossing and manipulation. The patient remained on apixaban for atrial fibrillation and clopidogrel postoperatively, had full neurological recovery over 2 weeks, with significant improvement in his kidney function. TRAS can safely be treated with PTA with/without coronary DES placement utilizing IVUS for most optimal sizing and angiographic outcome. The risk of stroke vs benefits with right upper extremity access should be carefully weighted in complex access cases.","journal":"Journal of the Society for Cardiovascular Angiography & Interventions","year":2023,"id":407362,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9548,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":55181,"name":"Stefanos Giannopoulos","orcid":"0000-0002-1942-911X","position":1,"is_corresponding":false},{"id":1186640,"name":"George J. Koullias","orcid":null,"position":2,"is_corresponding":false},{"id":1186405,"name":"Dimitrios Virvilis","orcid":"0000-0002-4465-3084","position":3,"is_corresponding":false},{"id":1186404,"name":"Panagiotis Volteas","orcid":"0000-0003-4779-6328","position":0,"is_corresponding":true}],"reference_count":0,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T01:21:10.867368Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}