Abdominal Aortic Aneurysm Repair After Renal Transplantation with Extracorporeal Bypass

Wolf, W; Ayisi, K.; Ismail, M.S.; Kalmár, P.; Pokar, H.; Trautwein, S.

doi:10.1055/s-2007-1020006

Cited by 30 publications

(14 citation statements)

References 2 publications

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“…Methods have been proposed with the unifying purpose of allowing effective aortic replacement while minimizing the risk of allograft loss. These include the use of temporary shunts (1, 2), extracorporeal bypass (3), cold renal perfusion (4, 5), and general hypothermia (6). However, there are also some reports of successful aneurysm repair without any adjunctive renal protective measures (16, 17).…”

Section: Discussionmentioning

confidence: 99%

Abdominal Aortic Aneurysm Repair in Patient with a Renal Allograft: A Case Report

et al. 2009

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Renal transplant recipients requiring aortic reconstruction due to abdominal aortic aneurysm (AAA) pose a unique clinical problem. The concern during surgery is causing ischemic injury to the renal allograft. A variety of strategies for protection of the renal allograft during AAA intervention have been described including a temporary shunt, cold renal perfusion, extracorporeal bypass, general hypothermia, and endovascular stent-grafting. In addition, some investigators have reported no remarkable complications of the renal allograft without any specific measures. We treated a case of AAA in a patient with a renal allograft using a temporary aortofemoral shunt with good result. Since this technique is safe and effective, it should be considered in similar patients with AAA and previously placed renal allografts.

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Section: Discussionmentioning

confidence: 99%

Abdominal Aortic Aneurysm Repair in Patient with a Renal Allograft: A Case Report

et al. 2009

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“…[7][8][9][10] Most of the techniques described, however, require an additional procedure and prolong operative times. As such, several authors have argued that renal protection is not required during aneurysm repair and that expeditious surgery and retrograde perfusion alone are sufficient to prevent ischemic injury.…”

Section: Discussionmentioning

confidence: 99%

Abdominal aortic aneurysm repair with a functional autotransplanted kidney

Lee

Lossing

Stewart

2012

CUAJ

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During the course of their practice, most urologists will encounter only a few patients with renal autotransplants. Even fewer will encounter those with renal autotransplants requiring abdominal aortic aneurysm (AAA) surgery. Although there is some literature describing AAA surgery in renal allotransplant patients, there is little such literature regarding AAA surgery in patients with autotransplanted kidneys. We present a case of a patient with a single, functioning, autotransplanted kidney who required AAA surgery. We also discuss the issue of the need for renal protection. IntroductionWith advancements in kidney transplantation and improved longterm allograft survival, 1 the once rare clinical scenario of an abdominal aortic aneurysm (AAA) in a patient with a functioning renal allograft has become much more familiar.2-5 Despite increasing numbers of case reports describing such scenarios, to date, the repair of AAAs in patients with autotransplanted kidneys is not well described in the literature. 6 In both allograft and autograft patients, AAA repair has the potential to cause irreversible ischemic injury. Two distinct approaches have been described to address this issue: methods that depend on expeditious surgery alone and those that use a specific form of renal protection. Some examples of such strategies include cold renal perfusion, general hypothermia, indwelling shunts, axillo-femoral bypass grafts and endovascular stent grafting. [2][3][4][5] We report a case of a 69-yearold female with a 6.0-cm AAA and an autotransplanted right pelvic kidney. Case ReportA 69-year-old female, while being investigated by her family physician for a recent history of general malaise and mild dyspnea, was found to have bilateral complex cystic and solid lesions on abdominal ultrasound. In addition, a 6.0-cm infrarenal AAA was also identified (Fig. 1). The patient's past medical history was also significant for hypertension, coronary artery disease, appendectomy and cholecystectomy.She went on to have an abdominal CT scan that demonstrated bilateral lesions highly suggestive of cystic renal cell carcinoma. There The initially planned partial left nephrectomy was converted to a radical nephrectomy, intraoperatively, owing to significant interval growth of the tumour since the last imaging. Approximately 6 weeks later, the patient underwent a right radical nephrectomy with ex vivo partial nephrectomy, renal reconstruction and autotransplantation into the right iliac fossa. Postoperatively, she briefly required renal replacement therapy but convalesced well and was discharged from hospital with a creatinine of 190 μmol/L.Seven months later, she was admitted to hospital for elective repair of her 6.0-cm AAA. On admission, her creatinine was 140 μmol/L. To minimize operative ischemic injury an external, 8.0-mm Dacron, right axillo-femoral bypass graft was placed before cross clamping of the aorta. This was left extracorporeal and was not tunneled subcutaneously. The AAA was then repaired without complication using a 16...

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“…iliaca berichteten erstmals Campbell et al 1981. Sie verwendeten bei einem Patienten mit BAA nach NTX einen femoral arteriovenös angeschlossenen Pumpenoxygenator zur retrograden Transplantatnierenperfusion.Weitere Autoren griffen die Methode auf, in der Literatur finden sich hierzu weitere Fallberichte [3,37], wobei in einem Fall eine Biomedicuspumpe zur Perfusion einer Einzelniere nach iliakorenalem Bypass eingesetzt wurde [32]. In allen Mitteilungen konnte auch durch die Verwendung einer extrakorporalen Zirkulation die Nierentransplantatfunktion uneingeschränkt erhalten werden.…”

Section: Verschiedene Protektionsverfahrenunclassified

“…So werden in der Literatur zwar zahlreiche Methoden der Ischämieprotektion angegeben, die berichteten Fallzahlen einer Klinik sind aber stets sehr gering, meist handelt es sich um Fallberichte [1,3,4,7,8,9,12,14,15,16,23,25,28,29,30,31,32,37]. Art und Notwendigkeit einer Ischämieprotektion bei aortoiliakalen Eingriffen nach NTX werden daher kontrovers diskutiert.Wir nahmen diese Situation zum Anlass, unser eigenes Krankengut vorzustellen, bei dem in Abhängigkeit von Art und Lokalisation des aortoiliakalen Gefäßprozesses verschiedene ischämieprotektive Verfahren angewendet wurden.…”

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Rekonstruktion der aortoiliakalen Strombahn bei Patienten nach Nierentransplantation Strategien zur Vermeidung einer ischämischen Transplantatschädigung

Pfeiffer

Böhner

Luther

et al. 2002

Chirurg

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Abdominal Aortic Aneurysm Repair After Renal Transplantation with Extracorporeal Bypass

Cited by 30 publications

References 2 publications

Abdominal Aortic Aneurysm Repair in Patient with a Renal Allograft: A Case Report

Abdominal Aortic Aneurysm Repair in Patient with a Renal Allograft: A Case Report

Abdominal aortic aneurysm repair with a functional autotransplanted kidney

Rekonstruktion der aortoiliakalen Strombahn bei Patienten nach Nierentransplantation Strategien zur Vermeidung einer ischämischen Transplantatschädigung

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