Helical computed tomography angiography is the most efficient test to assess vascular calcifications in the iliac arterial sector in renal transplant candidates

Andrès, Axel; Revilla, Yolanda; Ramos, Ana; González, Esther G.; Vereda, M; Praga, Manuel; Morales, Enrique; Morales, J. M.; Díaz, Rosana Saiz; Cruceyra, G; Aguirre, Frank V.; Leiva, O; Gragera, F

doi:10.1016/s0041-1345(03)00626-2

Cited by 22 publications

(20 citation statements)

References 4 publications

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“…The patient described in this report had undergone a CT angiography 18 months prior to renal transplant, at which time there was no evidence of calcification in the right common iliac or either external iliac artery. Despite this study, extensive calcifications were noted interestingly precluding direct arterial anastomosis, further highlighting the necessity for high risk renal transplant recipients to undergo vascular imaging every 6 -12 months while on the transplant list [11]. Therapeutic options are limited in patients with severe calcification of iliac artery and include orthotropic renal transplant or aorta and/or femoral bypass procedures, with or without direct anastomosis of the transplant artery to the prosthetic graft [1] [2] [5] [9] [10].…”

Section: Discussionmentioning

confidence: 80%

“…Increased arterial calcification has special implications in renal transplant recipients, especially when it occurs in the common iliacs, or the internal and the external iliac arteries, which are the potential sites for donor arterial anastomosis in a standard heterotrophic renal transplant. Traditionally, patients with severe and uniform calcifications of the iliac artery sector are excluded from renal transplant list, as at least 3 cm of disease free vessel is required to perform a satisfactory anastomosis [9]- [11]. In light of the fact some authors have recommended aortoiliac reconstruction as a bridge to renal transplantation in patients with severe calcification of iliac arteries [9] [12].…”

Section: Discussionmentioning

confidence: 99%

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Renal Transplantation in Patients with Aortoiliac Prosthetic Grafts: A Case Report and Pertinent Review of Literature

Patil¹,

Sun²,

Geffner³

et al. 2015

OJOTS

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Renal transplantation in a patient with aortoiliac prosthetic graft is a unique challenge. It requires that the renal artery is anastomosed directly to the vascular prosthetic graft. Nearly 0.2% -1.7% of the patients with aortoiliac prosthesis require renal transplantation in their life time. Outcomes following such procedure are controversial and anecdotal. In this report we present a unique case in which the renal artery was anastomosed to vascular prosthetic graft with a pertinent review of the literature.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Renal Transplantation in Patients with Aortoiliac Prosthetic Grafts: A Case Report and Pertinent Review of Literature

Patil¹,

Sun²,

Geffner³

et al. 2015

OJOTS

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“…16,17 Native CT scan of the pelvic region gives a good overview of the vascular situation and calcification which is especially due to media sclerosis. 18,45 In our scheme for assessment of iliac arterial calcification prior to renal transplantation, we use a grading similar to the one described in the subgroup of patients in the Framingham Heart Study 36,38 and which was also used in the CORD study, a large multicenter study with 47 participating centers in six northern European countries. 31 We used computed tomography, and the former study mentioned used lateral lumbar radiographs.…”

Section: Studies In General Populations From Various Regions Of the Wmentioning

confidence: 99%

“…This situation is not comparable with earlier cohorts. Careful surgical evaluation prior to renal transplantation has to be performed to ensure feasibility of surgical anastomosis with the renal graft, [16][17][18] but there is no supporting evidence in currently available guidelines. 19 In selected cases, vascular surgical intervention is necessary to make patients eligible prior to transplantation.…”

Section: Introductionmentioning

confidence: 99%

Calcification score evaluation in patients listed for renal transplantation

Kahn

Ram

Eberhard

et al. 2017

Clinical Transplantation

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Based on native CT scans of the pelvic region using a standardized calcification score, evaluation of iliac vascular calcification was performed between 2008 and 2012 prior to listing for renal transplantation in 205 patients with chronic kidney disease. Vascular calcification showed a decrease from proximal to distal. The difference between the degree of calcification in the common iliac artery and in the external iliac artery was significant (P<.001). Risk factors for total iliac vascular calcification were age, smoking, sex, underlying renal disease, and diabetes. Multivariate analysis revealed age to be the most relevant risk factor (P<.001). The duration of hemodialysis correlated significantly with total iliac vascular calcification. As the introduction of the standardized surgical evaluation protocol, no transplantation has had to be broken off and no early graft loss due to calcification has occurred. Thus, careful scoring of vascular calcification prior to transplantation may be a valuable tool to support surgical decisions and to improve patient safety and outcome in increasingly older transplant recipients.

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“…With few exceptions, a first kidney graft is placed extraperitoneally in the right iliac fossa (4) (Fig 1) by means of a rectus-preserving Gibson incision. This location allows access to a wider choice of arteries and veins for vascular reconstruction (5,6). The renal vein is anastomosed to the external iliac vein, usually medial to the external iliac artery.…”

Section: Heterotopic Renal Transplantationmentioning

confidence: 99%

Use of Multidetector CT in Presurgical Evaluation of Potential Kidney Transplant Recipients

Catalá¹,

Martí²,

Dı́az³

et al. 2010

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Kidney transplantation is the treatment of choice for end-stage renal disease. Optimal presurgical evaluation of the potential kidney transplant recipient is important for the success of the transplantation. Multidetector computed tomography (CT) allows assessment of the feasibility of kidney transplantation; detection of coexisting illnesses that may affect survival of the graft and that must be treated before transplantation; and evaluation of possible peripheral vascular disease, which is present in a significant number of potential kidney transplant recipients. Multidetector CT provides a wide range of information in these patients. Vascular and extravascular systems can be evaluated, allowing one to determine whether kidney transplantation is possible, whether presurgical procedures are necessary, and which is the best surgical technique for each candidate. Knowledge of the surgical techniques, use of an optimal multidetector CT technique, and the ability to identify common and uncommon radiologic findings are essential for correct evaluation of potential kidney transplant recipients.

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Helical computed tomography angiography is the most efficient test to assess vascular calcifications in the iliac arterial sector in renal transplant candidates

Cited by 22 publications

References 4 publications

Renal Transplantation in Patients with Aortoiliac Prosthetic Grafts: A Case Report and Pertinent Review of Literature

Renal Transplantation in Patients with Aortoiliac Prosthetic Grafts: A Case Report and Pertinent Review of Literature

Calcification score evaluation in patients listed for renal transplantation

Use of Multidetector CT in Presurgical Evaluation of Potential Kidney Transplant Recipients

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