Chimney-Patch Arterial Graft in Kidney or Pancreas Transplantation for Recipients with Heavily Calcified Iliac Arteries

Novel modified iliac artery stent graft with side branch extension facilitating kidney transplant in severe aortoiliac occlusive disease

Kidney transplant is the preferred treatment for patients with end-stage renal disease. However, a subset of otherwise eligible patients have severe iliac artery calcification that precludes them from receiving a kidney transplant. This report highlighted the application of a physician-modified external iliac artery stent graft with a side branch extension to facilitate successful kidney transplantation in a 69-year-old African American female who was otherwise ineligible for kidney transplant due to the presence of severe circumferential bilateral iliac artery calcification. Four months later, the patient received a kidney transplant and recovered without complications. Her duplex ultrasound revealed patent vasculature to the kidney graft, she produced adequate urine output, and creatinine and glomerular filtration rate normalized by discharge. This underscores the potential for stent graft with side branch extension as an option for patients who were traditionally ineligible for kidney transplantation due to the presence of severe aortoiliac calcification.

Vascular reconstruction of segmental intestinal grafts using autologous internal iliac vessels

Background

The aim of this study was to assess whether the autologous internal iliac artery and vein could be used as an interpositional graft for vascular reconstruction in segmental intestinal allografts and autografts.

Methods

Thirty-four intestinal transplants (19 living-related allografts and 15 autografts) were conducted in our programs between January 2011 and January 2019. Patient characteristics, type of vascular reconstruction, and post-operative complications were reviewed.

Results

There were 20 males and 14 females with a median age of 35 years. Of 34 grafts, 22 (64.7%) (11 allografts and 11 autografts) were revascularized using the autologous internal iliac artery and vein for reconstruction. Vascular reconstruction on the back table took 21 ± 6 min to complete. Both total operative time and cold ischemia time tended to be longer in the vascular-reconstruction group than in the direct-anastomosis group (530 ± 226 vs 440 ± 116 and 159 ± 49 vs 125 ± 66 min, respectively), but these differences were not significant. The incidence of vascular thrombosis tended to be higher in the direct-anastomosis group than in the vascular-reconstruction group (16.7% vs 0%, P = 0.118). At a median follow-up of 36.9 months, no stenosis or pseudoaneurysms developed. In 19 allografts, acute rejection occurred in 4 (21.1%) and chronic rejection occurred in 1 (5.2%).

Conclusions

Our results indicate that the use of an autologous internal iliac interposition graft greatly facilitates intestinal graft implantation and minimizes the risk of vascular complications.