Endovenous Iliocaval Revascularization for Transplant Kidney Salvage

Abstract

Purpose: We report the case of a venous iliocaval recanalization to preserve a transplant kidney. Case Report: A young patient with a nephrotic syndrome caused by focal segmental glomerulosclerosis (FSGS) underwent a robot-assisted living-donor kidney transplant. The postoperative course was uneventful; serum creatinine at discharge was 1.51 mg/dL (normal range = 0.72–1.17 mg/dL). In the course of the following months, the patient was readmitted repeatedly due to acute kidney failure not related to rejection, recurrent FSGS, or anastomotic stenosis. All episodes started after prolonged standing and renal function improved after bed rest. Several hospital admissions and investigations later, phlebography revealed an occlusion of the inferior vena cava (IVC) and both common iliac veins with large collateral vessels through the azygos system. An endovenous recanalization of the iliocaval tract was performed, with subsequent normalization of transplant kidney function. Conclusion: Vascular complications after renal transplantation are an important cause of graft loss. We present an endovenous treatment option for a chronic occlusion of the IVC and common iliac vein with intermittent venous congestion as a cause of transplant failure.

Lower Limb Weakness due to Spinal Venous Congestion in Chronic Inferior Vena Cava Occlusion: A Case Report

“…1,14-16 IVC recanalization for isolated IVC occlusion has been undertaken in case reports for other pathologies, including salvage of a renal transplant, and where other treatments for thrombosed IVC filters have failed. 17,18 Although the symptoms leading to treatment are unique in this case report, the technical outcomes and safety profile of this treatment are comparable to previously reported cases. Despite the emergence of endovenous treatments for symptomatic IVC occlusion, there is no consensus yet on indications for invasive treatment.…”