Iliac artery dissection – A rare complication of renal transplantation: A case report and literature review

Cheung, Fu Ho Victor; Ip, Chi Ho; Ma, Ka Fai Johnny; Lam, Yiu Chung; Chu, Tin Yu; Kit, Wai

doi:10.1016/j.eucr.2020.101429

Cited by 3 publications

(5 citation statements)

References 3 publications

(4 reference statements)

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“…It is also seen when there is size discrepancy and misalignment, torsion, or kinking of the anastomosis. Proposed risk factors include the presence of atherosclerosis, polycystic kidney disease, and vascular collagen disorder ( 1 , 20 , 29 , 30 ). Allograft function after TRAD can potentially be saved with appropriate treatment, including surgical revascularization or stent implantation ( 3 , 4 , 29 ).…”

Section: Discussionmentioning

confidence: 99%

“…Proposed risk factors include the presence of atherosclerosis, polycystic kidney disease, and vascular collagen disorder ( 1 , 20 , 29 , 30 ). Allograft function after TRAD can potentially be saved with appropriate treatment, including surgical revascularization or stent implantation ( 3 , 4 , 29 ). Even though we could not conclude the cause of the renal artery dissection in this case, there were multiple attributed risk factors, for instance, atherosclerosis and calcified lesions at the anastomosis site, difficulty of suture, and kinking of the anastomosis.…”

Section: Discussionmentioning

confidence: 99%

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Endovascular intervention with intravascular ultrasound guidance of very early dissection complication in transplant renal artery: a case report and literature review

Vu,

Nguyen,

Nguyen

et al. 2024

Front. Cardiovasc. Med.

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BackgroundTransplant renal artery dissection (TRAD) is a rare and serious event that can cause allograft dysfunction and eventually graft loss. Most cases are managed by operative repair. We report a case of TRAD in the early postoperative period, which was successfully managed with intravascular ultrasound-assisted endovascular intervention.Case presentationA 38-year-old man underwent HLA-compatible living kidney transplantation. The allograft had one renal artery and vein, which were anastomosed to the internal iliac artery and external iliac vein, respectively. Doppler ultrasonography performed a day after the operation showed an increase in systolic blood velocity, with no observed urine output and raising a suspicion of arterial anastomotic stenosis. Angiography showed a donor renal artery dissection distal to the moderately stenosed anastomosis site with calcified atherosclerotic plaque confirmed by IVUS. The transplant renal artery lesion was intervened with a stent. After the intervention, Doppler US revealed that the blood flow of the renal artery was adequate without an increase in the systolic blood velocity. Urine output gradually returned after 3 weeks, and serum creatinine level was normalized after 2 months.ConclusionsTransplant recipients commonly have atherosclerosis and hypertension, which are risk factors for arterial dissection. Our case showed that endovascular intervention can replace surgery to repair very early vascular complications such as dissection and help patients avoid high-risk operations. Early diagnosis and IVUS-assisted intervention with experienced interventionists can save allograft dysfunction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endovascular intervention with intravascular ultrasound guidance of very early dissection complication in transplant renal artery: a case report and literature review

Vu,

Nguyen,

Nguyen

et al. 2024

Front. Cardiovasc. Med.

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“…During the operation, loss of pulsation at the distal part of the anastomosis and deterioration in renal perfusion should suggest iliac artery dissection. [ 3 , 4 ]…”

Section: Discussionmentioning

confidence: 99%

“…During the operation, loss of pulsation at the distal part of the anastomosis and deterioration in renal perfusion should suggest iliac artery dissection. [3,4] Knowing the risk factors well is essential to be aware of external iliac artery dissection. As predisposing factors, diseases such as atherosclerosis, diabetes, hypertension, vascular collagen diseases, and polycystic kidney disease have been reported.…”

Section: Discussionmentioning

confidence: 99%

Repair experience of external iliac artery dissection using internal iliac artery transposition during renal transplantation

Bayraktar

2023

Ulus Travma Acil Cerrahi Derg

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Graft and surgery-related complications still pose a problem in kidney transplant surgery. Vascular complications due to surgery can be severe, threatening both graft and recipient life. Various treatment approaches have been described in the literature for vascular complications diagnosed peri-operatively and post-operatively. However, studies that provide long-term results on which approach will be applied in which period and in which conditions are limited. In this case report, we share our 6-year patient follow-up experience and repair of external iliac artery dissection related to renal transplantation with internal iliac artery transposition.

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“…In this case, the patient did not have diabetes or hyperlipidemia and there was no significant atherosclerosis noted in the vessels during transplantation. The timing of clamp-related dissections varies widely; however, most occur intraoperatively or during the immediate postoperative period 13. In the last 30 years, only five dissections have been described in the literature on postoperative day 1, all prompted by a constellation of clinical findings such as leg claudication/loss of distal pulses (3) and hypertension with anuria/oliguria (2).…”

Section: Discussionmentioning

confidence: 99%

Rescue of an asymptomatic arterial occlusion after kidney transplant

2022

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Arterial injury leading to vascular occlusion is a rare complication of kidney transplantation that requires urgent intervention to salvage the kidney and prevent graft loss. Occasionally, the recipient iliac vessels may be injured, resulting in acute ischaemia of the lower extremity in addition to loss of blood flow to the kidney transplant. In the case presented here, a 58-year-old man with chronic kidney disease secondary to IgA nephropathy underwent pre-emptive deceased donor renal transplantation complicated by an external iliac artery (EIA) dissection proximal to the transplant anastomosis. However, as a result of retrograde blood flow from collateral vessels, perfusion of the kidney and right lower extremity was initially preserved and early diagnosis was made after post-transplant ultrasound. This report reviews the aetiology, clinical features and therapeutic options for arterial injuries post-transplant. This case also highlights the importance of post-transplant vigilance and the value of routine postoperative ultrasound imaging.

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Iliac artery dissection – A rare complication of renal transplantation: A case report and literature review

Cited by 3 publications

References 3 publications

Endovascular intervention with intravascular ultrasound guidance of very early dissection complication in transplant renal artery: a case report and literature review

Endovascular intervention with intravascular ultrasound guidance of very early dissection complication in transplant renal artery: a case report and literature review

Repair experience of external iliac artery dissection using internal iliac artery transposition during renal transplantation

Rescue of an asymptomatic arterial occlusion after kidney transplant

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