Repair of an Autologous Saphenous Vein Graft Aneurysm Ten Years after Renal Artery Reconstruction during Live Donor Renal Transplantation

Abstract

Saphenous vein graft (SVG) aneurysms (SVGA) after renal transplantation represents a rare vascular complication with subsequent challenging multidisciplinary treatment. We present a case of a 30-year-old female who received a live donor kidney transplantation for end-stage renal disease that was caused due to the hemolytic uremic syndrome. Postoperatively, an insufficient graft perfusion due to an arterial kinking was noted and repaired using an autologous SVG interposition. Ten years later, a 3-cm aneurysm of the SVG at the anastomotic site with the common iliac artery was discovered. Multidisciplinary surgical exploration with excision of the aneurysm-carrying vein graft and interposition of a new autologous SVG was successfully carried out with preservation of renal allograft's function. Treatment of SVGA after rental transplantation with a new autologous SVG is challenging but feasible, requiring a multidisciplinary approach in order to guarantee successful rates and to prevent allograft loss.

Case Report: The Use of Cryopreserved Saphenous Vein in Reconstruction of Transplant Renal Artery Dissection

“…Previous studies with autologous saphenous vein transplant renal artery reconstruction have demonstrated concerns with late complications such as pseudoaneurysm formation and stenosis. [35][36][37] However, we have shown cryopreserved saphenous vein to be a potentially suitable alternative to saphenous vein autograft, prosthetic, or other conduits in the mid-term. Future studies are needed to determine the utility and safety of cryopreserved vessel allograft for long-term transplant vessel reconstruction.…”

In vivo successful repair of transplant renal artery aneurysm (TRAA) made possible in an Asian transplant unit.

“…It is a commonly used autologous graft for various vascular reconstruction. Although there are some reports on delayed saphenous vein graft aneurysms [4], the saphenous vein's caliber, length, ease of exploration and little venous drainage consequences when sacri ced has made it a versatile autologous graft. [4] A midline laparotomy was performed for direct access to the anteriorly placed aneurysm and iliac vessels.…”

“…Although there are some reports on delayed saphenous vein graft aneurysms [4], the saphenous vein's caliber, length, ease of exploration and little venous drainage consequences when sacri ced has made it a versatile autologous graft. [4] A midline laparotomy was performed for direct access to the anteriorly placed aneurysm and iliac vessels. A midline transperitoneal approach provided direct access to the renal transplant graft hilum and TRAA.…”

Successful repair of transplant renal artery aneurysm (TRAA)

“…It is a commonly used autologous graft for various vascular reconstruction. Although there are some reports on delayed saphenous vein graft aneurysms [ 3 ], the saphenous vein’s caliber, length, ease of exploration and little venous drainage consequences when sacrificed has made it a versatile autologous graft [ 3 ].…”