Saphenous vein graft aneurysm with graft-enteric fistula after renal artery bypass

Levy, Mark M.; Kiang, William; Johnson, Jason M.; Myers, Stuart I.

doi:10.1016/j.jvs.2008.03.045

Cited by 9 publications

(8 citation statements)

References 14 publications

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“…The development of aneurysmal change was recognized in these grafts 3 and 6 years after bypass grafting. In other studies, 3 cases of venous graft rupture after renal aortorenal bypass grafting have been reported [16][17][18], wherein rupture occurred 19 years, 22 years, and 30 years after bypass grafting. These cases suggest that long-term follow-up with Doppler US should be recommended in cases wherein the donor's gonadal vein grafts are used.…”

Section: Discussionmentioning

confidence: 95%

Arterial reconstruction using the donor’s gonadal vein in living renal transplantation with multiple renal arteries: a case report and a literature review

et al. 2020

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Background: Arterial reconstruction is one of the paramount procedures in kidney transplantation (KT) and greatly important if the procured kidney has multiple renal arteries (MRA). Despite various established techniques for arterial reconstruction, sometimes, the surgeon finds performing arterial anastomoses challenging in case of MRA. In our case, the donor's gonadal vein and recipient's internal iliac artery graft were used for arterial anastomoses, and 3 years after KT, the allograft did not present vascular complications. Case presentation: A 34-year-old man underwent ABO-incompatible preemptive living KT. The allograft had three renal arteries and four renal veins. After donor nephrectomy, arterial reconstruction was performed on a back table. These arteries were reconstructed into one piece using the recipient's internal iliac artery graft. The two arteries at the middle of the renal hilum were reconstructed using the conjoined method. As the superior renal artery was too short to anastomose, the donor's gonadal vein was used for extension. The internal iliac artery graft was anastomosed to the original internal iliac artery. Intraoperative Doppler ultrasonography revealed that the blood flow in each renal artery was adequate, resulting in sufficient blood flow throughout the allograft. The allograft function was maintained with a serum creatinine level of approximately 0.9 mg/dL without vascular complications 3 years after KT. Conclusions: The donor's gonadal vein can be a candidate for extension of the renal artery in the allograft with MRA. Further follow-up is needed for the assessment of long-term outcomes.

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Section: Discussionmentioning

confidence: 95%

Arterial reconstruction using the donor’s gonadal vein in living renal transplantation with multiple renal arteries: a case report and a literature review

et al. 2020

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“…Using the recipient's great saphenous vein (GSV) for the reconstruction of the damaged renal artery was also considered, but we had to consider the durability of the GSV. Lavigne et al [11] reported a case in which GSV was used for an aorto-renal bypass in a patient with renal arterial fibromuscular dysplasia who underwent aneurys- Other groups have also reported on the risk of delayed aneurysmal change after using GSV for renal arterial reconstruction [12][13][14]. One Japanese group reported using the donor's gonadal vein for the reconstruction of multiple renal arteries in living renal transplantation [15].…”

Section: Discussionmentioning

confidence: 99%

The use of polytetrafluoroethylene graft for damaged renal artery in ABO-incompatible living donor kidney transplantation: a case report

Chang

Shin

Park

et al. 2022

Korean J Transplant

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Short donor renal vessels during donor nephrectomy represent a technical challenge. The allograft of vessels from deceased donors can be an option for reconstruction; however, cryopreserved vessels are not routinely prepared for living donor kidney transplantation (LDKT). We report a reconstruction of the damaged short renal artery (RA) in LDKT using a polytetrafluoroethylene (PTFE) graft. A 45-year-old male patient underwent ABO-incompatible LDKT from his wife. After donor nephrectomy, we detected a hematoma surrounding the proximal RA of the allograft. The injured segment of the RA was transected, and the short RA was connected to the right external artery of the recipient; however, the blood flow was interrupted by the graft location. Once the arterial anastomosis was removed, the graft was flushed with cold saline, and a PTFE graft was used for the reconstruction of the short RA. Immediate blood flow to the renal graft was excellent without sign of parenchymal infarction until fascial closure. Renal graft Doppler on postoperative day 7 and 3 months showed good blood flow. In this patient, the use of PTFE graft presented no additional morbidity to the kidney transplantation, and no postoperative complications related to its use were noted.

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“…However, due to thrombosis, intimal hyperplasia, and atherosclerotic degeneration, saphenous vein graft has a higher risk of occlusion and long-term complications such as aneurysms and ruptures. Furthermore, access to the vein requires an additional incision [20,21]. Internal iliac artery graft is usually used in cases with three or more polar arteries and is taken from the recipient.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of a Lower Polar Artery for Kidney Transplantation Using Donor Ovarian Vein: Case Report with Literature Review

et al. 2021

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Background: In the case of complicated kidney transplantation, when the accessory artery is severed, the main task is to decide whether to restore renal blood flow and which method should be used. In this report, we present a case of kidney transplantation with vascular reconstruction using an ovarian vein as an interposition graft between a larger branch of the main renal artery and the lower polar artery which was severed during kidney explantation. Case summary: Kidney transplantation using an ovarian vein was performed for a 34-year-old woman with end-stage renal disease on 1 April 2020 in the Hospital of Lithuanian university of health sciences (LUHS) Kaunas Clinics. A lower accessory renal artery was severed during kidney explantation. As the ovarian vein of the donor remained and matched the diameter of the severed vessel, it was decided to use it as an insertion between the main renal artery and the accessory renal artery of the inferior pole. The cold ischemic time was 770 min and the warm ischemic time was 37 min. A month after transplantation, the patient’s condition and daily urine output were normal and the serum creatinine level decreased rapidly. Fifteen months after the surgery, the function and structure of the transplant remained normal and there was no evidence of serious vascular complications on CT scans. This is the first case where graft function was verified after transplantation using three-dimensional CT angiography. Conclusions: If an inferior polar artery is severed, vascular reconstruction must be performed to preserve the function of the graft. Usually, the gonadal vein is available during donor nephrectomy; therefore, it can be explanted without additional difficulties or incisions. Although we have not reported any complications, further studies are recommended on the long-term outcomes of this alternative approach for the reconstruction of short renal arteries.

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Saphenous vein graft aneurysm with graft-enteric fistula after renal artery bypass

Cited by 9 publications

References 14 publications

Arterial reconstruction using the donor’s gonadal vein in living renal transplantation with multiple renal arteries: a case report and a literature review

Arterial reconstruction using the donor’s gonadal vein in living renal transplantation with multiple renal arteries: a case report and a literature review

The use of polytetrafluoroethylene graft for damaged renal artery in ABO-incompatible living donor kidney transplantation: a case report

Reconstruction of a Lower Polar Artery for Kidney Transplantation Using Donor Ovarian Vein: Case Report with Literature Review

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