Aortic Reconstruction in Patients with Functioning Renal Allografts

Skelly, Christopher L.; Farmer, Amy J.; Curi, Michael A.; Meyerson, Shari L.; Davidovitch, Roy S.; Woo, David H.; Schwartz, Lewis B.

doi:10.1007/s10016-001-0195-4

Cited by 7 publications

(3 citation statements)

References 21 publications

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“…[2][3][4][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.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Introductionmentioning

confidence: 99%

“…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. …”

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confidence: 99%

Abdominal aortic aneurysm repair with a functional autotransplanted kidney

Lee

Lossing

Stewart

2012

CUAJ

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“…Das in den letzten Jahrzehnten und teilweise immer noch inadäquate Screening von Transplantatempfängern hinsichtlich der Präsenz eines Bauchaortenaneurysmas (AAA) führte zur Notwendigkeit einer Reoperation bei Patienten nach NTx zur Ausschaltung eines AAA. Bis 2002 fanden Skelly et al eine publizierte Gesamterfahrung von 113 Patienten mit Ausschaltung eines AAA nach NTx [32]. In einer retrospektiven Studie wiesen Englesbe et al ein schnelleres Wachstum eines Aneurysmas bei Patienten mit Organtransplantation nach [6].…”

Section: Introductionunclassified

Endovaskuläre Therapie eines infrarenalen Aortenaneurysmas bei heterotopem Nierentransplantat

Tsilimparis

Alevizakos²,

Yousefi³

et al. 2007

Zentralbl Chir

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All data existing in the literature reported to date as well as our own experience justify the first choice of EVAR in morphologically suitable cases. One major advantage of EVAR in this constellation is the avoidance of aortic cross clamping which poses the graft at risk of ischemia. Long-term results will be most important for definite assessment of EVAR. However, contrast media application during the operation and for CT surveillance should be considered as a major disadvantage.

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