Unprovoked Arterial Thrombosis with Limb-threatening Ischemia in the Immediate Postrenal Transplantation Period: Interventional Radiology-assisted Salvage

A BSTRACT Peripheral arterial thrombosis in the early posttransplant period is rare and may prove to be organ or limb-threatening. We report the case of a 28-year-old renal transplant recipient who developed acute unprovoked brachial, radial, and ulnar artery thrombosis during early postoperative hospitalization after transplant. The initial presentation was sudden onset arteriovenous fistula dysfunction associated with the symptoms of limb ischemia. A multidisciplinary approach involving interventional radiology (IR) and cardiovascular thoracic surgery led to prompt diagnosis and treatment. Under IR guidance, catheter-directed thrombolysis with minimal-dose alteplase (2.5 mg) and thrombosuction was successfully performed, salvaging the ischemic limb. The patient was transitioned to apixaban and discharged in stable condition. This case highlights the need for early suspicion and tailored thrombolytic strategies in posttransplant patients presenting with subtle vascular signs and the importance of a multidisciplinary team approach.