Aortoiliac Surgery and Kidney Transplantation

Gouny, P; Lenot, Bernard; B, Decaix; Rondeau, Éric; Kitzis, M; Lacave, Roger; Bensenane, J.; Nussaume, O

doi:10.1007/bf02021773

Cited by 61 publications

(28 citation statements)

References 15 publications

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“…4,7,9,17 Note that this problem also exists with both Lacombe's modification and standard technique. This general limitation is, however, restricted only to allograft protection, since the basic hemodynamic advantages of an ACC of short duration are still important.…”

Section: Discussionmentioning

confidence: 92%

Reducing Cross-Clamping Duration in Aortoiliac Reconstruction After Renal Transplantation

et al. 1996

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A fifty-two-year-old male renal transplant patient underwent aortoiliac reconstruction with a bifurcated prosthesis for treatment of hypertension and deteriorating allograft function. A modified technique was used that reduced aortic cross-clamping time to twelve minutes. This simple technique is applicable to most patients, reduces warm ischemia to a minimum, and saves time for a careful aortoiliac reconstruction.

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Section: Discussionmentioning

confidence: 92%

Reducing Cross-Clamping Duration in Aortoiliac Reconstruction After Renal Transplantation

et al. 1996

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“…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. [11][12][13][14][15][16] Although evidence does suggest that renal protection is not required in all cases, some form of renal protection may be important when aortic reconstruction is expected to be difficult or if there is an element of renal insufficiency to suggest significant sensitization to warm ischemia.…”

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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“…Our patient was asymptomatic but had impalpable femoral pulses which has been suggested as an indication for vascular work-up in renal transplant patients with deteriorating renal function [17]. Aorto-iliac surgery during kidney transplantation [18] and specifically temporary axillo-femoral bypass graft for renal transplant protection during aortic aneurysm repair or excision of mycotic abdominal aneurysm, has previously been reported [19][20][21][22]. However, this is the first record, to the best of our knowledge, of successful nontemporary (permanent) revascularization of renal graft and extremities by axillofemoral bypass graft.…”

Section: Discussionmentioning

confidence: 99%

Renal Transplant Dysfunction due to Severe Aorto-Iliac Atherosclerosis in the Presence of Patent Renal Transplant Artery

Tovbin¹,

Feldman²,

Basok³

et al. 2000

Am J Nephrol

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We report a case of progressive deterioration in renal function and decreased renal graft perfusion induced by extensive aorto-iliac atherosclerotic lesions proximal to a patent renal graft artery. Significant improvement in kidney graft function followed left axillo-femoral bypass graft surgery, which to the best of our knowledge, has never been performed previously for permanent maintenance of renal transplant perfusion.

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Aortoiliac Surgery and Kidney Transplantation

Cited by 61 publications

References 15 publications

Reducing Cross-Clamping Duration in Aortoiliac Reconstruction After Renal Transplantation

Reducing Cross-Clamping Duration in Aortoiliac Reconstruction After Renal Transplantation

Abdominal aortic aneurysm repair with a functional autotransplanted kidney

Renal Transplant Dysfunction due to Severe Aorto-Iliac Atherosclerosis in the Presence of Patent Renal Transplant Artery

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