Endovascular abdominal aortic aneurysm repair in patients with renal transplant

Abstract

The repair of abdominal aortic aneurysm (AAA) in patients with functioning renal transplant is critical because it is important to avoid ischemic and reperfusion injury to the transplanted kidney. Endovascular aneurysm repair (EVAR) avoids aortic cross clamping and can prevent renal graft ischemia. Here we report the endovascular management and outcome of AAA in two renal transplant patients using a bifurcated aortic stent graft. One patient underwent EVAR using a small amount of contrast (30 mL) due to decreased renal function resulting from chronic rejection. Another patient had EVAR performed with iliac conduit because of the heavily calcified, stenotic lesion of external iliac artery. EVAR in patients with a renal transplant is a feasible option without impairing renal arterial flow.

Hybrid Percutaneous Brachiofemoral Shunt and Open Abdominal Aortic Aneurysm Repair in a Kidney Transplant Recipient

“…A different renal protecting mechanism could be the endovascular repair. The benefit is that the allograft ischemia is limited to a short time that the graft is ballooned into place, but the disadvantages are the emboli to the kidney from dislodged atherosclerotic debris during the procedure as well as the risk of contrast-induced nephropathy [ 7 , 11 ].…”

“…He was receiving tacrolimus, mycophenolic acid, and prednisolone after the transplantation. The patient developed with abdominal pain and raising serum creatinine (2.6 mg/dl), and abdominopelvic sonography revealed normal transplanted kidney with a large infrarenal abdominal aortic aneurysm (anterioposterior diameter of 55 mm) which did not involve the iliac arteries, and Femoral V-A bypass [4] Pump-oxygenation bypass technique [5] Axillofemoral shunt [5,6,8] Atriofemoral bypass [7] Endovascular aneurysm repair (EVAR) [5,7] Topical cooling [5,7] Aortofemoral shunt [8] Femorofemoral bypass with extracorporeal circulation [6][7][8] Operation without renal allograft protection [9] Femoropoliteal bypass [9] Permanent and temporary axillofemoral bypass [7][8][9] Saphenous vein branchiorenal shunt [10] Aortoiliac shunt [7,10] Cold perfusion of the graft [7][8][9]11] General hypothermia [8,9,11] Case Reports in Vascular Medicine then, computed tomography (CT) scan without contrast confirmed the diagnosis (Figures 1-3).…”

Abdominal Aortic Aneurysm Repair in Renal and Liver Transplant Recipients

“…5 Further scarring from previous transplant surgery makes iliac artery fixed to the surrounding tissue, preventing straightening of tortuous vessels with a stiffwire, impeding the insertion of a larger device. 21…”

“…It is also important to accurately measure the required graft length intraoperatively using a measuring catheter specially on the side of the transplant in order to avoid covering the origin of the transplant artery. 21 Due to heavy calcification and acute angulation of iliac arteries that wouldn’t straighten up with stiff wire due to transplant surgery; anticipate the need for a brachial approach for snaring the contralateral gate for cannulation. Use of image overlay, navigation systems, and CO 2 angiograms to reduce the use of contrast agents again is important as well as reducing numerous pump runs to reduce contrast usage.…”

“…5 Further scarring from previous transplant surgery makes iliac artery fixed to the surrounding tissue, preventing straightening of tortuous vessels with a stiffwire, impeding the insertion of a larger device. 21 When deploying stent through the side of transplant organ, use of low-profile sheaths/devices has been recommended to maintain flow into the graft during instrumentation. We deployed the main body and ipsilateral limb completely if the transplant side had to be used for main-body insertion in order to withdraw the sheath early and reestablish flow into the transplant organ quickly.…”