Abstract:A potential problem during endovascular aortic aneurysm repair (EVAR) or open repair in renal allograft patients is ischemia of the transplanted kidney. In this study, kidney transplant patients who underwent aortic aneurysm repair in our institution were added to similar cases extracted from the literature to represent the basis of this work. Comparisons between patients treated with open surgery versus EVAR were performed in terms of renal function. In the EVAR group, most aneurysms were infrarenal, and 84% … Show more
“…Different techniques have been introduced to reduce the risk of ischemia during open surgery repairs, such as axillofemoral bypass, aortoiliac bypass, femoral artery to femoral vein bypass with pump oxygenators, local allograft cooling, mannitol and fluid loading [ 7 , 9 ]. However, none has proved to have any more advantage than a ‘clamp-and-go’ strategy [ 10 ].…”
Management of abdominal aortic aneurysms (AAA) tends to be an issue in patients with a previous history of abdominal transplantation surgeries. Open surgery poses the risk of ischemia to the grafted tissue. Additionally, these patients have comorbidities that make them unable to endure such procedures. As a result, endovascular repair is becoming the accepted procedure in the transplanted population. Herein, we describe a patient with a previous history of simultaneous orthotopic liver-kidney transplantation who successfully underwent EVAR for AAA correction.
“…Different techniques have been introduced to reduce the risk of ischemia during open surgery repairs, such as axillofemoral bypass, aortoiliac bypass, femoral artery to femoral vein bypass with pump oxygenators, local allograft cooling, mannitol and fluid loading [ 7 , 9 ]. However, none has proved to have any more advantage than a ‘clamp-and-go’ strategy [ 10 ].…”
Management of abdominal aortic aneurysms (AAA) tends to be an issue in patients with a previous history of abdominal transplantation surgeries. Open surgery poses the risk of ischemia to the grafted tissue. Additionally, these patients have comorbidities that make them unable to endure such procedures. As a result, endovascular repair is becoming the accepted procedure in the transplanted population. Herein, we describe a patient with a previous history of simultaneous orthotopic liver-kidney transplantation who successfully underwent EVAR for AAA correction.
“…[10]. В 2009 г. Leon представил мета-анализ лечения АБА у больных с пересаженной почкой [11]. По его данным, к 2009 г. были выпол-нены 19 эндопротезирований аорты и 138 откры-тых резекций аорты у пациентов после пересадки почки.…”
Контактная информация: Андрей Евгеньевич Зотиков, профессор, д.м.н., ведущий научный сотрудник отделения хирургии сосудов Института хирургии им. А.В. Вишневского, Москва, Россия, e-mail: zotikov@ixv.
“…Comparisons between patients treated with open surgery versus EVAR were performed in terms of renal function [8]. In the EVAR group, the pre- and postoperative creatinine (Cr) was 1.69 and 1.73 mg/dL, respectively, (P = 0.412) without any protective kidney allograft perfusion measures.…”
The repair of abdominal aortic aneurysm (AAA) in patients with functioning renal transplant is critical because it is important to avoid ischemic and reperfusion injury to the transplanted kidney. Endovascular aneurysm repair (EVAR) avoids aortic cross clamping and can prevent renal graft ischemia. Here we report the endovascular management and outcome of AAA in two renal transplant patients using a bifurcated aortic stent graft. One patient underwent EVAR using a small amount of contrast (30 mL) due to decreased renal function resulting from chronic rejection. Another patient had EVAR performed with iliac conduit because of the heavily calcified, stenotic lesion of external iliac artery. EVAR in patients with a renal transplant is a feasible option without impairing renal arterial flow.
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