Abdominal aortic aneurysm repair with a functional autotransplanted kidney

Abstract

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...

Surgical Repair of Abdominal Aortic Aneurysm in Patients with Simultaneous Urological Disorders: a Single Center Experience

“…In both allograft and autograft cases, there is a single renal artery and no collateral vasculature. Apart from the AAA repair, the goal is to avoid irreversible ischemic renal injuries due to warm ischemia, but there is not a widely accepted surgical protocol in AAA repair, yet ( 30 ).…”