Emergency Endovascular Repair in a Patient With Abdominal Aortic Aneurysm With Pelvic Transplant Kidneys: Case Report

Abstract

Abdominal aortic aneurysms after a kidney transplant are becoming treated more frequently owing to the extension of renal transplant in severely arteriosclerotic older patients. Renal transplant recipients with autosomal dominant polycystic kidney disease are prone to develop abdominal aortic aneurysms. We present the case of a ruptured abdominal aortic aneurysm that occurred in a renal transplant patient with autosomal dominant polycystic kidney disease. The patient was treated with emergency endovascular repair because open surgery could not be performed successfully owing to the presence of massive polycystic native kidneys and a liver that was occupying the entire peritoneal cavity. His postoperative course was uneventful without complications. The important lessons to be learned from our case are 2-fold: (1) Autosomal dominant polycystic kidney disease renal transplant recipients should be screened annually for abdominal aortic aneurysms to prevent ruptures and (2), emergency endovascular repair may be a preferred treatment in renal transplant recipients owing to its low surgical risk and success.

Endovascular abdominal aortic aneurysm repair in a patient with previous history of simultaneous orthotopic liver kidney transplantation

“…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 ].…”

Elective Endovascular Aneurysm Repair (EVAR) for the Treatment of Infrarenal Abdominal Aortic Aneurysms of 5.0–5.5 cm: Differences between Men and Women

“…Endovascular aortic aneurysm repair (EVAR), is widely proven to have better early results when compared to open surgery (OS) [ 10 ], although there is evidence that females who received either OS or EVAR, remain at higher risk of postoperative mortality than males [ 11 ]. Previous studies showed the disparities of risks and outcomes of AAA between the two sexes, on the basis of a unique treatment indistinctly used either electively or in emergency [ 12 , 13 , 14 ], with far worse outcomes in females. Furthermore, there are inherent morphological dissimilarities between male and female patients, as the disease is intrinsically different among the two sexes [ 15 ].…”

Bilateral Nephrectomy for Adult Polycystic Kidney Disease Does Not Affect the Graft Function of Transplant Patients and Does Not Result in Sensitisation

“…An association with other systemic manifestations is also frequent: polycystic liver disease, mitral valve prolapse or ventricular hypertrophy [8], intracranial aneurysm, abdominal aortic aneurysm [7], diverticular disease [5], and bronchiectasis [8]. For abdominal aortic aneurysm in particular, they tend to expand more rapidly in transplanted patients, and in the case of massively enlarged polycystic kidneys, the surgical access for a ruptured abdominal aortic aneurysm could be very challenging [9]; therefore variation in clinical symptoms has to be carefully assessed.…”