Endovascular therapy for transplant renal artery stenosis based on anatomical foundations and three-dimensional digital subtraction angiography: A retrospective, single-center study

Objective Endovascular recanalization is the preferred treatment for peripheral vascular diseases. This study evaluated the short-term outcomes of endovascular therapy for transplant renal artery stenosis (TRAS) administered based on anatomical foundations and three-dimensional digital subtraction angiography (3D-DSA). Methods Patients with TRAS treated with endovascular therapy at a single center between October 2022 and October 2023 were retrospectively analyzed. The primary endpoint was the 12-month primary patency rate, defined as uninterrupted vessel patency without reintervention. Secondary endpoints included secondary patency rate (patency maintained after reintervention), blood pressure, and serum creatinine (Scr) levels. Results The study included 23 patients (mean age: 41.1 ± 11.5 years; 9 females). All patients underwent successful plain old balloon angioplasty (POBA); 13 underwent POBA plus balloon-expandable bare-metal stent (BMS) deployment. The procedure-related complication rate was 13.04%. Technical success was defined as <30% residual stenosis with restoration of antegrade flow at completion angiography and was achieved in all cases (100%). The median follow-up was 14.9 ± 2.3 months (range11–19 months). The 12-month primary and secondary patency rates were 86.96% and 100%, respectively. The primary patency rates significantly differed between the POBA + BMS (100%) and POBA-only (70%) groups (P = 0.032). The systolic and diastolic blood pressure, pulse pressure, and Scr levels significantly differed pre- and post-operatively. No stent-related complications occurred. Conclusions Endovascular treatment of TRAS based on anatomical foundations and 3D-DSA is safe and effective with a high patency rate. POBA with BMS might be a better solution.