Transplant Renal Artery Stenosis Revascularization: Common Distal External Iliac Bypass

2020 ◽  
Author(s):  
Santiago J. Miyara ◽  
Christopher C. Ortiz ◽  
Sara Guevara ◽  
Alexia Molmenti ◽  
Gerardo Tamayo-Enriquez ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Renal Artery ◽  
Iliac Artery ◽  
Duplex Ultrasound ◽  
External Iliac Artery ◽  
Artery Stenosis ◽  
Ptfe Graft ◽  
Transplanted Kidney ◽  
Renal Hilum ◽  
Arterial Anastomosis

AbstractStenosis proximal to transplant renal artery anastomoses are complications leading to allograft dysfunction. This study was aimed to evaluate a novel surgical approach to renal allograft revascularization, taking into consideration the length of time elapsed since transplantation. We describe an arterial bypass using a polytetrafluoroethylene (PTFE) graft from the common iliac artery (proximal to the renal artery implantation) to the external iliac artery (distal to the renal artery implantation) that allows the adequate revascularization of both the transplant kidney, as well as the lower extremity. This technique provides several advantages when compared with previously described procedures to revascularize a transplanted kidney with an iliac artery stenosis proximal to the allograft implantation site. Benefits of this technique include (1) no need to repair the stenosis, (2) no need to take down and redo the arterial anastomosis, (3) no need to perform a dissection around the renal hilum of the transplanted kidney, (4) no requirement to address the anastomosis transfer, and (5) no need to perfuse the kidney with preservation fluid at the time of repair and/or (6) avoidance of potential injury to the renal parenchyma and/or hilum during dissections. Adequate perfusion of the organ, as well as of the lower extremity was verified by serial Doppler duplex ultrasound evaluations. Hence, we describe a novel revascularization technique in instances of kidney transplant and lower extremity ischemia.

Simultaneous endovascular revascularization of external iliac artery dissection and transplant renal artery stenosis in a recent renal allograft recipient

2021 ◽  
Vol 20 ◽  
Author(s):  
Rajesh Vijayvergiya ◽  
Atit Gawalkar ◽  
Ganesh Kasinadhuni ◽  
Ashish Sharma ◽  
Sarbpreet Singh ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Iliac Artery ◽  
Vascular Complications ◽  
External Iliac Artery ◽  
Artery Stenosis ◽  
Artery Dissection ◽  
Renal Allograft Recipient ◽  
Transplant Renal Artery Stenosis

Abstract Various vascular complications following renal transplantation include renal artery and vein thrombosis, renal artery stenosis, pseudoaneurysm, and iliac artery dissection. Transplant renal artery stenosis (TRAS) is the most common, while iliac artery dissection is the rarest of these various vascular complications. We describe an elderly male, who had both external iliac artery dissection and TRAS at 2 months following renal transplantation. He underwent successful percutaneous endovascular intervention of both complications. The post-intervention course was uneventful, with improvement in graft renal functions and left lower limb perfusion.

scholarly journals Different techniques of vessel reconstruction during kidney transplantation

2015 ◽  
Vol 72 (7) ◽  
pp. 614-618 ◽  
Author(s):  
Aleksandar Tomic ◽  
Novak Milovic ◽  
Ivan Marjanovic ◽  
Zoran Bjelanovic ◽  
Ivan Lekovic ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Renal Artery ◽  
Iliac Artery ◽  
Standard Procedure ◽  
External Iliac Artery ◽  
Renal Arteries ◽  
Ptfe Graft ◽  
Renal Artery Reconstruction ◽  
Kidney Transplantations ◽  
Vessel Reconstruction

Background/Aim. Multiple renal arteries (MRAs) represent a surgical challenge by the difficulty in performing anastomoses, bleeding and stenosis. MRAs should be preserved and special attention should be paid to accessory polar arteries. All renal arteries (RAs) must be reconstructed and prepared for safe anastomosis. The paper decribed the different techniques of vessel reconstruction during kidney transplantation including important steps within recovery of organs, preparation and implantation. Methods. In a 16-year period (1996-2012) of kidney transplantation in the Military Medical Academy, Belgrade, a total of 310 living donors and 44 human cadaver kidney transplantations were performed, of which 28 (8%) kidneys had two or more RAs. Results. All the transplanted kidneys had immediate function. We repaired 20 cases of donor kidneys with 2 arteries, 4 cases with three RAs, one case with 4 RAs, one case with 4 RAs and renal vein reconstruction, one case with 3 arteries and additional polytetrafluoroethylene (PTFE) graft reconstruction, one case with transected renal artery and reconstruction with 5 cm long deceased donor external iliac artery. There were no major complications and graft failure. At a minimum of 1-year follow-up, all the patients showed normal renal function. Conclusion. Donor kidney transplantation on a contralateral side and ?end-to-end? anastomosis of the renal artery to the internal iliac artery (IIA) is our standard procedure with satisfactory results. Renal artery reconstruction and anastomosis with IIA is a safe and highly efficient procedure and kidneys with MRAs are not contraindicated for transplantation. A surgical team should be fully competent to remove cadaveric abdominal organs to avoid accidental injuries of organs vessels.

MO233RENAL ARTERY STENOSIS: DO NOT FORGET INHERITED THROMBOPHILIA

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Marwa Omrane ◽  
Yosra Ben Ariba ◽  
Imen Ouertani ◽  
Jannet Labidi
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Renal Artery ◽  
High Blood Pressure ◽  
Protein C ◽  
Artery Bypass ◽  
Duplex Ultrasound ◽  
Protein S ◽  
Artery Stenosis ◽  
Inherited Thrombophilia

Abstract Background and Aims Inherited thrombophilia can be defined as a genetically determined predisposition to develop thromboembolic complications. Inherited prothrombotic risk factors include antithrombin deficiency, protein C and protein S deficiencies, activated protein C resistance due to Leiden factor V mutation, inherited hyperhomocysteinemia, prothrombin G20210A variant, dysfibrinogenemia and elevated factor VIII levels. Method We report the case of a patient with history of bilateral renal artery stenosis who presented with renal artery bypass thrombosis related to an inherited thrombophilia. Results We report a case of 40-year-old male patient who presented with extremely high blood pressure and hypokalemia without other biological abnormalities. The duplex ultrasound showed bilateral renal stenosis with chronic occlusion of the right renal artery and a tight stenosis of the left renal artery estimated at 50%. Renal angiography confirmed the bilateral stenosis, associated to a small right kidney. Renal scintigraphy with DMSA showed normal left renal function and right renal function estimated at 2%. The therapeutic decision was to perform an aorto-renal bypass surgery by the saphenous vein.After renal artery bypass the blood pressure improved markedly, maintaining this result at 12 months follow-up at clinical examination and duplex ultrasound. One year later, the patient presented with high blood pressure. The duplex ultrasound showed a stenosis of the bypass with a double stenosis of the left aorto renal bypass on renal angioscanner. The patient underwent angioplasty of the venous bridge with implantation of 2 stents with improvement of blood pressure after angioplasty. Six months later, the patient presented an unbalanced blood pressure, the ultrasound control with a vascular Doppler showed a stenosis at the stent. The antihypertensive treatment was increased, a thrombophilia balance was requested concluding a combined protein C and protein S deficiency. Conclusion An etiological assessment should be carried out systematically in the event of thrombosis occurring before the age of 40 or in the case of iterative venous or arterial thrombosis. A genetic study where appropriate and a family screening are then recommended.

Sequential anastomosis of accessory renal artery to external iliac artery in the management of renal transplantation with multiple arteries

2003 ◽  
Vol 35 (1) ◽  
pp. 329-331 ◽  
Author(s):  
H.R Davari ◽  
S.A Malek-Hossini ◽  
H Salahi ◽  
A Bahador ◽  
G.A Rais-Jalali ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Artery ◽  
Iliac Artery ◽  
External Iliac Artery ◽  
Accessory Renal Artery

scholarly journals A successful hybrid operation for life-threatening hemorrhagic shock secondary to an iatrogenic ruptured pseudoaneurysm of the external iliac artery following percutaneous arterial access

2018 ◽  
Vol 14 (3) ◽  
Author(s):  
Takahiro Shoji ◽  
Hirohisa Harada ◽  
Shinji Yamazoe ◽  
Yoshihiro Yamaguchi
Keyword(s):  
Renal Artery ◽  
Iliac Artery ◽  
Arterial Embolization ◽  
External Iliac Artery ◽  
Vascular Trauma ◽  
Balloon Occlusion ◽  
Arterial Access ◽  
Iatrogenic Complications ◽  
Life Threatening ◽  
Endovascular Balloon Occlusion

Intravascular treatments such as arterial embolization and resuscitative endovascular balloon occlusion of the aorta are being increasingly performed in emergency cases, in addition to the increasing use of arterial access as an intensive care monitoring tool. Thus, arterial access-related complications are being commonly reported. A 40- year-old man with renal artery stenosis underwent renal artery stent placement via the left inguinal puncture approach. After the procedure, his groin was manually compressed to hemostasis for 30 min. He unexpectedly developed shock the following day, and computed tomography revealed a ruptured pseudoaneurysm of the left external iliac artery (EIA) following iatrogenic vascular trauma owing to an inappropriately performed groin puncture. We initially controlled the hemorrhage using endovascular balloon occlusion of the left EIA. Subsequently, the injured EIA was repaired using a direct suture. The postoperative course was uneventful. Herein, we evaluated the causes of iatrogenic complications and the effectiveness of our treatment strategy.

Follow-up of renal artery stenosis by duplex ultrasound

1989 ◽  
Vol 9 (3) ◽  
pp. 0410-0415 ◽  
Author(s):  
David C. Taylor ◽  
Gregory L. Moneta ◽  
D. Eugene Strandness
Keyword(s):  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Duplex Ultrasound ◽  
Artery Stenosis

Retrospective evaluation of the endovascular repair of the anastomotic pseudoaneurysm of the transplanted renal artery using the snorkel technique

Vascular ◽  
2020 ◽  
Vol 28 (4) ◽  
pp. 475-480
Author(s):  
Che Haijie ◽  
Song Fubo ◽  
Li Xiaoying ◽  
Yu Ying ◽  
Pu Zenghui
Keyword(s):  
Renal Artery ◽  
Endovascular Treatment ◽  
Stent Thrombosis ◽  
Iliac Artery ◽  
Endovascular Repair ◽  
External Iliac Artery ◽  
Covered Stent ◽  
Retrospective Evaluation ◽  
Feasible Method ◽  
Anastomotic Pseudoaneurysm

Objective To evaluate the endovascular repair of the transplanted renal artery anastomotic pseudoaneurysm using the snorkel technique. Methods From April 2012 to December 2017, we performed endovascular repair in six patients, who were diagnosed with transplanted renal artery anastomotic pseudoaneurysm, using the snorkel technique. The “snorkel” stent and the “parallel” stent were placed in the transplanted kidney and the external iliac artery, respectively. Another covered stent was implanted at the proximal end of the external iliac artery to match the diameter of the iliac artery. Result and conclusion: Of the six patients, three patients recovered. Two patients experienced pseudoaneurysm rupture due to infection, and one patient developed stent thrombosis; all three patients underwent graft nephrectomy. The endovascular treatment of transplanted renal artery anastomotic pseudoaneurysm with the snorkel technique is a feasible method but needs to comply with certain indications.

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