Percutaneous transluminal angioplasty with carbon dioxide for peripheral arterial disease after kidney transplantation: a case report with literature review

Abstract

Abstract Background Arteriosclerosis may progress and lead to peripheral arterial disease (PAD) during the waiting period until kidney transplantation in end-stage kidney disease (ESKD) patients. Additionally, contrast-induced nephropathy (CIN) of a kidney allograft after the examination and treatment for PAD is problematic. Here, we report the case of a kidney transplant recipient with PAD in the lower extremities who underwent percutaneous transluminal angioplasty (PTA) with carbon dioxide to prevent CIN incidence. Case presentation A 57-year-old woman underwent a cadaveric kidney transplant when she was 49 years old. Immunosuppression was maintained with tacrolimus, methylprednisolone, and mycophenolate mofetil. Her post-transplant course was uneventful, and serum creatinine level was maintained at 1.1–1.3 mg/dL. Intermittent claudication of the lower legs began 3 years after transplantation. Under saline intravenous rehydration, computed tomographic angiographies were performed, and the patient was diagnosed with PAD in the bilateral lower extremities. Total PTA was performed thrice for PAD in the lower extremities via a combination of carbon dioxide and iodinated contrast medium to prevent CIN incidence at 3, 4, and 7 years after kidney transplantation. The patient’s recoveries were uneventful. One year later, the serum creatinine level was maintained at 0.9–1.1 mg/dL, and since then, the patient has shown no evidence of recurrence. Conclusions In a kidney transplant recipient with PAD, PTA with carbon dioxide was effective to minimize the volumes of iodinated contrast medium and prevent CIN incidence.

Keywords

• Arteriosclerosis obliterans
• Carbon dioxide
• Contrast-induced nephropathy
• Kidney transplantation
• Percutaneous transluminal angioplasty
• Peripheral arterial disease