Renal Transplantation with Simultaneous Aortoiliac Reconstruction Using a Polytetrafluoroethylene Vascular Graft for Severe Atherosclerosis

Studies on aortoiliac reconstruction for severe atherosclerosis with renal transplantation are limited. Here, we report a rare experience of the simultaneous reconstruction of the external iliac artery caused by severe atherosclerosis with polytetrafluoroethylene vascular graft and renal transplantation in a 55-year-old female; she was unable to undergo standard renal artery anastomosis to the right external iliac artery because of severe atherosclerosis, which would result in complete occlusion. Next, we directly anastomosed the donor renal artery to the polytetrafluoroethylene graft. After transplantation, delayed graft function occurred; therefore, the patient had to undergo hemodialysis. On day 7 after transplantation, her creatine level started to decrease. She was discharged from the hospital on the 14th day after transplantation. After 1 month, her serum creatinine level reduced to 1.12 mg/dL. After 3 years of transplantation, her serum creatinine level was 1.2 mg/dL. The simultaneous implantation of the polytetrafluoroethylene graft and renal transplantation was feasible as well as safe, with no infectious complications and stable renal function noted on long time follow-up. Although our case was rare, it emphasizes the need for transplant surgeons to gain surgical skills for vascular surgery using vascular grafts.

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

Transplantation Proceedings ◽

10.1016/s0041-1345(02)03838-1 ◽

2003 ◽

Vol 35 (1) ◽

pp. 329-331 ◽

Cited By ~ 6

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

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Relation between resistive index and serum creatinine level in first month after renal transplantation

Transplantation Proceedings ◽

10.1016/j.transproceed.2003.09.054 ◽

2003 ◽

Vol 35 (7) ◽

pp. 2628-2629 ◽

Cited By ~ 12

Author(s):

M.R Ardalan ◽

M.K Tarzamani ◽

M Mortaazavi ◽

A Bahloli

Keyword(s):

Renal Transplantation ◽

Serum Creatinine ◽

Serum Creatinine Level ◽

Creatinine Level ◽

Resistive Index

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

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.210035 ◽

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.

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Endovascular Treatment of Transplant Renal Artery Stenosis: A Systematic Review and Meta-analysis

Journal of Endovascular Therapy ◽

10.1177/15266028211038593 ◽

2021 ◽

pp. 152660282110385

Author(s):

David Eugenio Hinojosa-Gonzalez ◽

Gustavo Salgado-Garza ◽

Mauricio Torres-Martinez ◽

Sergio Uriel Villegas-De Leon ◽

Luis Carlos Bueno-Gutierrez ◽

...

Keyword(s):

Systematic Review ◽

Renal Function ◽

Serum Creatinine ◽

Renal Artery ◽

Serum Creatinine Level ◽

Endovascular Treatment ◽

Renal Artery Stenosis ◽

Creatinine Level ◽

Mean Difference ◽

Artery Stenosis

Objective Endovascular treatment through either percutaneous transluminal angioplasty (PTA) alone or stenting has been previously used as a treatment for transplant renal artery stenosis (TRAS). This review aimed to investigate the results of endovascular treatment for renal artery stenosis in transplanted kidneys as compared with the outcomes of interventions, medical management, and graft survival in non-TRAS patients. Methods A systematic review of PubMed, Google Scholar, Cochrane, and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in which studies that reported outcomes of the treatment of TRAS via the endoluminal approach were identified, and their results were meta-analyzed. Results Fifty-four studies with a total of 1522 patients were included. A significant reduction of serum creatinine level was found, favoring the stenting group, with a mean difference of 0.68 mg/dL (95% confidence interval (CI), 0.17–1.19; Z=2.60, p=0.0009). Comparison of pre- and post-intervention values of any intervention revealed a significant decrease in overall serum creatinine level (0.65 mg/dL; 95% CI, 0.40–0.90; Z=5.09, p=0.00001), overall blood pressure, with a mean difference of 11.12 mmHg (95% CI, 7.29–14.95; Z=5.59, p=0.00001), mean difference in the use of medications (0.77; 95% CI, 0.29–1.24; p=0.002), and peak systolic velocity (190.05; 95% CI, 128.41–251.69; p<0.00001). The comparison of serum creatinine level between endovascular interventions and best medical therapy favored endovascular intervention, with a mean difference of 0.23 mg/dL (95% CI, 0.14–0.32; Z=5.07, p<0.00001). Graft survival was similar between the treated patients and those without TRAS (hazard ratio, 0.98; 95% CI, 0.75–1.28; p=0.091). The overall pooled success rate was 89%, and the overall complication rate was 10.4%, with the most prevalent complication being arterial dissection. Conclusion The endovascular treatment of TRAS improves graft preservation and renal function and hemodynamic parameters. PTA + stenting appears to be a more effective option to PTA alone in the stabilization of renal function, with additional benefits from decreased restenosis rates. Further high-quality studies could expand on these findings.

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