Matteo Tozzi1, Marco Franchin2, Gabriele Soldini2, Giuseppe Ietto2, Corrado Chiappa1, Beatrice Molteni2, Francesco Amico2, Giulio Carcano2, Renzo Dionigi3. 1. Unit of General Surgery and Organ Transplantation, Insubria University, Varese, Italy; Unit of Vascular Surgery, Insubria University, Varese, Italy. 2. Unit of General Surgery and Organ Transplantation, Insubria University, Varese, Italy; Unit of General Surgery, Insubria University, Varese, Italy. 3. Unit of General Surgery, Insubria University, Varese, Italy.
Abstract
BACKGROUND AND PURPOSE: Aortoiliac (AI) lesions (both dilatative and occlusive) can occur in kidney allograft recipients. The correct timing of vascular imaging and treatment is controversial. Aim of the present paper is to report our experience. METHODS: between January 2010 and December 2012, 106 patients included in our waiting list for kidney transplant underwent computed tomography (CT) angiogram to study AI axis. In 21 cases an AI lesion was identified before transplant. In 3 cases surgery was mandatory before kidney transplant, and in 18 cases lesions were treated simultaneously with kidney transplantation. MAIN FINDINGS: AI pathology distribution was as follows: 15 iliac stenoses treated with thromboendarterectomy (TEA), 2 Leriche syndrome and 1 aortic aneurism treated with an aortobisiliac bypass (AI-BP), and 3 aneurysms treated with endovascular aortic repair (EVAR). In two cases a postoperative hematoma occurred. In one case occlusion of a stent-graft branch was treated with a femoro-femoral crossover bypass and transplant was then performed on the contralateral iliac axis. Perioperative mortality was 0%, and graft survival rate was 100% at 1 year in all cases. CONCLUSIONS: A CT angiogram is useful in order to detect AI lesions and to be able to evaluate the best treatment option for the kidney transplantation and the correct timing for additional vascular surgery. The EVAR procedure should be safe, and does not compromise anastomosis success and graft survival, with less postoperative complications than open surgery.
BACKGROUND AND PURPOSE: Aortoiliac (AI) lesions (both dilatative and occlusive) can occur in kidney allograft recipients. The correct timing of vascular imaging and treatment is controversial. Aim of the present paper is to report our experience. METHODS: between January 2010 and December 2012, 106 patients included in our waiting list for kidney transplant underwent computed tomography (CT) angiogram to study AI axis. In 21 cases an AI lesion was identified before transplant. In 3 cases surgery was mandatory before kidney transplant, and in 18 cases lesions were treated simultaneously with kidney transplantation. MAIN FINDINGS: AI pathology distribution was as follows: 15 iliac stenoses treated with thromboendarterectomy (TEA), 2 Leriche syndrome and 1 aortic aneurism treated with an aortobisiliac bypass (AI-BP), and 3 aneurysms treated with endovascular aortic repair (EVAR). In two cases a postoperative hematoma occurred. In one case occlusion of a stent-graft branch was treated with a femoro-femoral crossover bypass and transplant was then performed on the contralateral iliac axis. Perioperative mortality was 0%, and graft survival rate was 100% at 1 year in all cases. CONCLUSIONS: A CT angiogram is useful in order to detect AI lesions and to be able to evaluate the best treatment option for the kidney transplantation and the correct timing for additional vascular surgery. The EVAR procedure should be safe, and does not compromise anastomosis success and graft survival, with less postoperative complications than open surgery.
Authors: Shabnam Babakry; Elsaline Rijkse; Joke I Roodnat; Diederik C Bijdevaate; Jan N M IJzermans; Robert C Minnee Journal: Clin Transplant Date: 2021-11-09 Impact factor: 3.456
Authors: Elsaline Rijkse; Jacob L van Dam; Joke I Roodnat; Hendrikus J A N Kimenai; Jan N M IJzermans; Robert C Minnee Journal: Transpl Int Date: 2020-03-04 Impact factor: 3.842