Isolated iliac artery stenosis as a cause of kidney graft dysfunction post-transplant

We report the case of a kidney transplant recipient who, 1 yr post-transplant, presented with a serum creatinine level elevation secondary to iliac artery stenosis proximal to the graft anastomosis site. Stenosis of the transplant renal artery was initially suspected because of new onset of hypertension in addition to the rising creatinine level. Physical examination, however, revealed a diminished femoral pulse and a significantly lower ankle-brachial index on the right (versus left) lower extremity; these findings suggested a stenosis of the right iliac artery. Angiography confirmed a short stenotic lesion of the external iliac artery just proximal to the graft anastomosis site. The lesion - given its focal nature, its location, and the absence of disease elsewhere in the peripheral vascular system - was most consistent with a vascular clamp injury. The stenosis was managed by placement of an intravascular stent at the time of angiography. This resulted in normalization of the vascular examination findings, return to baseline of the serum creatinine level, and resolution of hypertension. This case demonstrates the value of physical examination in diagnosing this uncommon cause of an increased serum creatinine level post-transplant and the effectiveness of intravascular stents for its management.