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Ajduk M, Šljaka M, Đurić I, Keserica D, Gagula Ž, Glavinić N, Fila B, Šalamon T, Šitum A, Pelegrin VZ. The Femoral Venoarterial Perfusion During Open Abdominal Aortic Aneurysm Repair in Patient With Renal Transplant. Ann Vasc Surg 2021; 79:439.e1-439.e5. [PMID: 34655749 DOI: 10.1016/j.avsg.2021.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/16/2021] [Accepted: 07/30/2021] [Indexed: 11/28/2022]
Abstract
We report of a patient with abdominal aortic aneurysm and renal transplant who underwent aneurysm repair. These patients can be treated by eather open or endovascular approach, depending on several factors, including aneurysm morphologic suitability for endovascular tretament, age of patient, and comorbidities.The main challange with open repair approach is to maintain renal transplant perfusion during the aortic cross clamping. Several methods of renal transplant perfusion during aneurysm repair have been described. In this case, we opted for open aneurysm repair beacuse of the age of the patient. The femoral venoarterial perfusion technique using extracorporal circulation machine was employed. We found this technique safe and easy in treating such patients.
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Affiliation(s)
- Marko Ajduk
- Department of Vascular Surgery, University Hospital Dubrava, Zagreb, Croatia.
| | - Maja Šljaka
- Department of General Surgery, General hospital Zadar, Zadar, Croatia
| | - Iva Đurić
- Department of Vascular Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Dražen Keserica
- Department of Vascular Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Željka Gagula
- Department of Vascular Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Nikola Glavinić
- Department of Vascular Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Branko Fila
- Department of Vascular Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Tomislav Šalamon
- Department of Vascular Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Andrej Šitum
- Department of Vascular Surgery, University Hospital Dubrava, Zagreb, Croatia
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Premaratne S, Hopkins J, Duddy M, Tai KS, Kay M, Rogoveanu R, Nicholl P, Tiwari A. Abdominal Aortic Aneurysm Repair in Renal and Liver Transplant Recipients. Vasc Endovascular Surg 2019; 54:51-57. [PMID: 31601161 DOI: 10.1177/1538574419880673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) repair in patients with organ transplant remains a challenge. We looked at AAA repair in patients with organ transplants at our tertiary liver and kidney transplant unit. METHODS A retrospective analysis of a prospectively maintained database was undertaken from January 2008 to July 2018. We looked at patient demographics, type of repair, and technical success including reinterventions, perioperative transplant organ function, and 30-day and 1-year survival rate. Eight of 662 patients who underwent AAA repair had a solid organ transplant. Of these, 5 were kidney transplants, 2 liver transplants, and 1 had kidney and liver transplant; 75% were male; and average age was 63.4 (range: 49-83). All patients had asymptomatic AAAs, and 6 were treated with standard endovascular repair, 1 standard repair with iliac branch device, and 1 open repair. Adjunctive techniques such as CO2 angiograms, deployment of main body through contralateral iliac, low-profile sheaths, custom-made stent grafts, and temporary axillo-femoral shunting were used to protect transplant organs. Thirty-day survival was 100% with 1 death at 5 months from liver failure, and 1 patient has a persistent type-2 endoleak 3 years after the procedure. CONCLUSION Abdominal aortic aneurysm repair in patients with organ transplants can be undertaken using adjunctive endovascular and open surgical techniques.
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Affiliation(s)
- Sobath Premaratne
- Department of Vascular Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Jonathan Hopkins
- Department of Interventional Radiology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Martin Duddy
- Department of Interventional Radiology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Ket Sang Tai
- Department of Interventional Radiology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Mark Kay
- Department of Vascular Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Radu Rogoveanu
- Department of Vascular Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Phil Nicholl
- Department of Vascular Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
| | - Alok Tiwari
- Department of Vascular Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
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Ali O, Nicholl P, Carruthers D, Geoghegan J, Tiwari A. Multiple Aneurysms and a Transplanted Kidney in Behçet Disease. Vasc Endovascular Surg 2017; 51:108-110. [PMID: 28147897 DOI: 10.1177/1538574417689982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Arterial manifestation of Behçet disease represents a challenging clinical scenario with a potential for fatal complications. This case depicts the surgical management of a 4.5-cm infrarenal aortic aneurysm and a 6-cm left renal artery aneurysm in a patient with known Behçet disease. The presence of a contralateral living donor kidney transplant added to the complexity of the case. Open surgical repair was performed on both aneurysms with the use of axillofemoral bypass to protect the transplanted kidney. This case highlights the challenges of treating an aortic aneurysm in a patient with Behçet disease and a kidney transplant.
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Affiliation(s)
- Oroog Ali
- 1 Department of Vascular Surgery, University Hospital Birmingham, Birmingham, United Kingdom
| | - Philip Nicholl
- 1 Department of Vascular Surgery, University Hospital Birmingham, Birmingham, United Kingdom
| | - David Carruthers
- 2 Department of Rheumatology, City Hospital, Birmingham, United Kingdom
| | - James Geoghegan
- 3 Department of Anesthetics, University Hospital Birmingham, Birmingham, United Kingdom
| | - Alok Tiwari
- 1 Department of Vascular Surgery, University Hospital Birmingham, Birmingham, United Kingdom
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Yamauchi T, Takano H, Kin K, Maeda S. Repair of Internal Iliac Artery Aneurysm Anastomosed to Donor Renal Artery in a Renal Transplant Patient. Ann Vasc Dis 2016; 9:220-222. [PMID: 27738467 DOI: 10.3400/avd.cr.16-00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 06/09/2016] [Indexed: 11/13/2022] Open
Abstract
We herein report a successful repair of an internal iliac artery aneurysm in a renal transplant patient. At renal transplantation, the main renal artery and accessory renal artery had been anastomosed to the right internal iliac artery and right external iliac artery, respectively. The patient underwent resection and graft replacement of the iliac artery aneurysm with reattachment of the main renal artery to the right external iliac artery through a midline laparotomy with repeated topical cold perfusion for renal protection. The postoperative course was uneventful, and no evidence of renal function impairment was present at discharge.
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Affiliation(s)
- Takashi Yamauchi
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Osaka, Japan; Department of Cardiovascular Surgery, KKR Sapporo Medical Center, Sapporo, Hokkaido, Japan
| | - Hiroshi Takano
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Keiwa Kin
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Shuusaku Maeda
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Osaka, Japan
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Monnot A, Rouer M, Horion J, Plissonnier D. Axillofemoral Bypass for Kidney Transplant Protection during Open Repair of Abdominal Aortic Aneurysm. Ann Vasc Surg 2015; 29:1315.e1-2. [DOI: 10.1016/j.avsg.2015.04.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 01/29/2015] [Accepted: 04/30/2015] [Indexed: 11/25/2022]
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Silverberg D, Yalon T, Halak M. Endovascular Repair of Abdominal Aortic Aneurysms in the Presence of a Transplanted Kidney. Cardiovasc Intervent Radiol 2014; 38:833-9. [DOI: 10.1007/s00270-014-1027-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 10/25/2014] [Indexed: 12/19/2022]
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Ucar M, Erdil F, Sanlı M, Aydogan MS, Durmus M. Anesthesia Management in Aortic Dissection in Patients Undergoing Kidney Transplant. EXP CLIN TRANSPLANT 2014; 14:227-9. [PMID: 25375956 DOI: 10.6002/ect.2014.0100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Kidney transplant is a last resort to increase the life expectancy and quality of life in patients with renal failure. Aortic dissection is a disease that requires emergency intervention; it is characterized by sudden life-threatening back or abdominal pain. In the case described, constant chest pain that increased with respiration was present on examination of a 28-year-old man (85 kg, 173 cm) who presented at our emergency department complaining of severe back pain. He had undergone a kidney transplant in 2004 from his mother (live donor). He was diagnosed with acute Type II aortic dissection and was scheduled for emergent surgery. Because there were no surgical or anesthetic complications, the patient with 79 and 89 minutes aortic cross-clamping and cardiopulmonary bypass durations was sent, intubated, to intensive care unit. When nephrotoxic agents are avoided and blood flow is stabilized, cardiovascular surgery with cardio-pulmonary bypass may be performed seamlessly in patients who have undergone a kidney transplant.
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Affiliation(s)
- Muharrem Ucar
- From the Department of Anesthesiology and Reanimation, Inonu University, Faculty of Medicine, Malatya, Turkey
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Miranda MP, Genzini T, Noujaim H, Mota LT, Branez JR, Ianhez LE, Azevedo R, Shiroma ETM. Aortic clamping in pancreas transplantation: is there any harm to the transplanted kidney graft? Transplant Proc 2012; 44:2397-8. [PMID: 23026604 DOI: 10.1016/j.transproceed.2012.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Some special situations may require aortic clamping during pancreas transplantation (PT). The most important problem is ischemic injury to a previous transplanted kidney. We sought to demonstrate experience with aortic clamping in PT without special kidney allograft protection measures and its impact on kidney function. METHODS Retrospective study that analyzed 6 patients who underwent PT (5 pancreas after kidney and 1 simultaneous pancreas-kidney) with aortic clamping. In all cases, the pancreas graft was placed on the right with retrocolic portal-enteric drainage. Serum creatinine was evaluated pre- and posttransplantation. RESULTS The average clamping time was 19 minutes. The mean serum creatinine was 1.1, 1.15, 0.95, and 1.0, respectively, at pre and postoperative days 1 and 7 and at hospital discharge. Patient, kidney, and pancreatic graft survivals were 100%, 100%, and 83%, respectively. CONCLUSION The need for aortic clamping in selected cases of PT did not seem to affect the transplanted kidney, even without protective measures, provided that the ischemic time was short.
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Affiliation(s)
- M P Miranda
- Grupo Hepato and Bandeirantes and Beneficência Portuguesa Hospitals, São Paulo, Brazil.
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Gallagher KA, Ravin RA, Schweitzer E, Stern T, Bartlett ST. Outcomes and Timing of Aortic Surgery in Renal Transplant Patients. Ann Vasc Surg 2011; 25:448-53. [DOI: 10.1016/j.avsg.2010.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 12/19/2010] [Accepted: 12/26/2010] [Indexed: 01/16/2023]
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Sadat U, Huguet E, Varty K. Abdominal Aortic Aneurysm Surgery in Renal, Cardiac and Hepatic Transplant Recipients. Eur J Vasc Endovasc Surg 2010; 40:443-9. [DOI: 10.1016/j.ejvs.2010.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 07/10/2010] [Indexed: 10/19/2022]
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Dalio MB, Bredarioli M, Joviliano EE, Cherri J, Suaid HJ, Piccinato CE. Endovascular repair of an aorto-iliac aneurysm succeeded by kidney transplantation. J Vasc Bras 2010. [DOI: 10.1590/s1677-54492010000300012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We present the case of aorto-iliac aneurysm in a patient with chronic renal failure requiring dialysis who were treated with an endovascular stent graft and, later on, submitted to kidney transplantation. A 53-year-old male with renal failure requiring dialysis presented with an asymptomatic abdominal aorto-iliac aneurysm measuring 5.0cm of diameter. He was treated with endovascular repair technique, being used an endoprosthesis Excluder®. After four months, he was successfully submitted to kidney transplantation (dead donor), with anastomosis of the graft renal artery in the external iliac artery distal to the endoprosthesis. The magnetic resonance imaging, carried out 30 days after the procedure, showed a good positioning of the endoprosthesis and adequate perfusion of the renal graft. In the follow-up, the patient presented improvement of nitrogenous waste, good positioning of the endoprosthesis without migration or endoleak. The endovascular repair of aorto-iliac aneurysm in a patient with end-stage renal failure under hemodialysis treatment showed to be feasible, safe and efficient, as it did not prevent the success of the posterior kidney transplantation.
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Kim HK, Ryuk JP, Choi HH, Kwon SH, Huh S. Abdominal aortic aneurysm repair in patient with a renal allograft: a case report. J Korean Med Sci 2009; 24:166-9. [PMID: 19270833 PMCID: PMC2651000 DOI: 10.3346/jkms.2009.24.1.166] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 01/19/2008] [Indexed: 01/16/2023] Open
Abstract
Renal transplant recipients requiring aortic reconstruction due to abdominal aortic aneurysm (AAA) pose a unique clinical problem. The concern during surgery is causing ischemic injury to the renal allograft. A variety of strategies for protection of the renal allograft during AAA intervention have been described including a temporary shunt, cold renal perfusion, extracorporeal bypass, general hypothermia, and endovascular stent-grafting. In addition, some investigators have reported no remarkable complications of the renal allograft without any specific measures. We treated a case of AAA in a patient with a renal allograft using a temporary aortofemoral shunt with good result. Since this technique is safe and effective, it should be considered in similar patients with AAA and previously placed renal allografts.
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Affiliation(s)
- Hyung-Kee Kim
- Division of Transplantation and Vascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Jong-Pil Ryuk
- Division of Transplantation and Vascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Hyang Hee Choi
- Division of Transplantation and Vascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Sang-Hwy Kwon
- Division of Transplantation and Vascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Seung Huh
- Division of Transplantation and Vascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, Korea
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Leon LR, Glazer ES, Hughes JD, Bui TD, Psalms SB, Goshima KR. Aortoiliac Aneurysm Repair in Kidney Transplant Recipients. Vasc Endovascular Surg 2008; 43:30-45. [DOI: 10.1177/1538574408322654] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
A potential problem during endovascular aortic aneurysm repair (EVAR) or open repair in renal allograft patients is ischemia of the transplanted kidney. In this study, kidney transplant patients who underwent aortic aneurysm repair in our institution were added to similar cases extracted from the literature to represent the basis of this work. Comparisons between patients treated with open surgery versus EVAR were performed in terms of renal function. In the EVAR group, most aneurysms were infrarenal, and 84% were treated with modular bifurcated devices. Protective kidney allograft perfusion measures were not used. The pre- and postoperative Cr was 1.69 and 1.73 mg/dL, respectively (P = .412). All EVAR patients had good outcomes. Complications included 8 endoleaks and 1 limb ischemia case. Three patients died from aortic repair-unrelated reasons. In the open group, the pre-and postoperative Cr was 1.45 and 1.37 mg/dL, respectively (P = .055). Most cases were infrarenal and mostly treated by aortobiiliac bypasses. In 16%, no adjuvant allograft perfusion was provided. In the rest, temporary axillofemoral bypasses were used most often. Most outcomes were favorable (57%). Reported procedural-related complications included arterial embolism, wound infection, and pneumonia. Deaths were reported in 5 occasions (none allograft failure dependent). No differences in Cr between EVAR and open techniques (P = .13) were seen. Aneurysm repair in kidney transplant recipients is associated with excellent renal preservation. Adverse outcomes were all allograft failure independent in both groups. EVAR without special allograft protection measures seems to be equally effective as open surgery with or without adjuvant kidney transplant perfusion.
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Affiliation(s)
- Luis R. Leon
- Southern Arizona Veteran Affairs Health Care System (SAVAHCS) and University of Arizona Health Science Center (AHSC), Vascular Surgery Section, Tucson, Arizona,
| | - Evan S. Glazer
- Southern Arizona Veteran Affairs Health Care System (SAVAHCS) and University of Arizona Health Science Center (AHSC), Vascular Surgery Section, Tucson, Arizona
| | - John D. Hughes
- Southern Arizona Veteran Affairs Health Care System (SAVAHCS) and University of Arizona Health Science Center (AHSC), Vascular Surgery Section, Tucson, Arizona
| | - Trung D. Bui
- Southern Arizona Veteran Affairs Health Care System (SAVAHCS) and University of Arizona Health Science Center (AHSC), Vascular Surgery Section, Tucson, Arizona
| | - Shemuel B. Psalms
- Southern Arizona Veteran Affairs Health Care System (SAVAHCS) and University of Arizona Health Science Center (AHSC), Vascular Surgery Section, Tucson, Arizona
| | - Kaoru R. Goshima
- Southern Arizona Veteran Affairs Health Care System (SAVAHCS) and University of Arizona Health Science Center (AHSC), Vascular Surgery Section, Tucson, Arizona
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