Abdominal Aortic Aneurysm Repair in a Patient With Bilateral Autotransplanted Kidneys

Neelakandhan, Kurur Sankaran; Muralidhar, R; Unnikrishnan, Madathipat; Ravimandalam, K.

doi:10.1055/s-2007-1016472

Cited by 7 publications

(3 citation statements)

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“…Bei der Mehrheit der Patienten kam es postoperativ zu einem vorübergehenden Anstieg des Serumkreatinins, wobei die präoperativen Kreatininspiegel innerhalb von 10 Tagen wieder erreicht wurden. In 3 Fällen mit stenosebedingten Perfusionsstörungen der Transplantatniere kam es sogar zu einer anhaltenden Funktionsverbesserung [18,19].Weitere Autoren verzichteten ebenfalls auf eine Protektion der Transplantatniere bei rekonstruktiven Operationen der aortoiliakalen Strombahn, ohne dass ischämische Nierenschädigungen auftraten [1,5,10,11,13,22].…”

Section: Verschiedene Protektionsverfahrenunclassified

Rekonstruktion der aortoiliakalen Strombahn bei Patienten nach Nierentransplantation Strategien zur Vermeidung einer ischämischen Transplantatschädigung

Pfeiffer

Böhner

Luther

et al. 2002

Chirurg

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Section: Verschiedene Protektionsverfahrenunclassified

Rekonstruktion der aortoiliakalen Strombahn bei Patienten nach Nierentransplantation Strategien zur Vermeidung einer ischämischen Transplantatschädigung

Pfeiffer

Böhner

Luther

et al. 2002

Chirurg

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“…6 In both allograft and autograft patients, AAA repair has the potential to cause irreversible ischemic injury. Two distinct approaches have been described to address this issue: methods that depend on expeditious surgery alone and those that use a specific form of renal protection.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4][5] Despite increasing numbers of case reports describing such scenarios, to date, the repair of AAAs in patients with autotransplanted kidneys is not well described in the literature. 6 In both allograft and autograft patients, AAA repair has the potential to cause irreversible ischemic injury. Two distinct approaches have been described to address this issue: methods that depend on expeditious surgery alone and those that use a specific form of renal protection.…”

Section: Introductionmentioning

confidence: 99%

Abdominal aortic aneurysm repair with a functional autotransplanted kidney

Lee

Lossing

Stewart

2012

CUAJ

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During the course of their practice, most urologists will encounter only a few patients with renal autotransplants. Even fewer will encounter those with renal autotransplants requiring abdominal aortic aneurysm (AAA) surgery. Although there is some literature describing AAA surgery in renal allotransplant patients, there is little such literature regarding AAA surgery in patients with autotransplanted kidneys. We present a case of a patient with a single, functioning, autotransplanted kidney who required AAA surgery. We also discuss the issue of the need for renal protection. IntroductionWith advancements in kidney transplantation and improved longterm allograft survival, 1 the once rare clinical scenario of an abdominal aortic aneurysm (AAA) in a patient with a functioning renal allograft has become much more familiar.2-5 Despite increasing numbers of case reports describing such scenarios, to date, the repair of AAAs in patients with autotransplanted kidneys is not well described in the literature. 6 In both allograft and autograft patients, AAA repair has the potential to cause irreversible ischemic injury. Two distinct approaches have been described to address this issue: methods that depend on expeditious surgery alone and those that use a specific form of renal protection. Some examples of such strategies include cold renal perfusion, general hypothermia, indwelling shunts, axillo-femoral bypass grafts and endovascular stent grafting. [2][3][4][5] We report a case of a 69-yearold female with a 6.0-cm AAA and an autotransplanted right pelvic kidney. Case ReportA 69-year-old female, while being investigated by her family physician for a recent history of general malaise and mild dyspnea, was found to have bilateral complex cystic and solid lesions on abdominal ultrasound. In addition, a 6.0-cm infrarenal AAA was also identified (Fig. 1). The patient's past medical history was also significant for hypertension, coronary artery disease, appendectomy and cholecystectomy.She went on to have an abdominal CT scan that demonstrated bilateral lesions highly suggestive of cystic renal cell carcinoma. There The initially planned partial left nephrectomy was converted to a radical nephrectomy, intraoperatively, owing to significant interval growth of the tumour since the last imaging. Approximately 6 weeks later, the patient underwent a right radical nephrectomy with ex vivo partial nephrectomy, renal reconstruction and autotransplantation into the right iliac fossa. Postoperatively, she briefly required renal replacement therapy but convalesced well and was discharged from hospital with a creatinine of 190 μmol/L.Seven months later, she was admitted to hospital for elective repair of her 6.0-cm AAA. On admission, her creatinine was 140 μmol/L. To minimize operative ischemic injury an external, 8.0-mm Dacron, right axillo-femoral bypass graft was placed before cross clamping of the aorta. This was left extracorporeal and was not tunneled subcutaneously. The AAA was then repaired without complication using a 16...

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