Kidney transplantation in recipients with atherosclerotic iliac vessels.
ABSTRACT The influence of atherosclerotic lesions of hypogastric and iliac arteries of kidney recipients on intraoperative surgical technique and one-year graft and patient survival was investigated. Among 1553 transplanted kidneys atherosclerotic lesions which required surgical intervention were found in 201 (12.9%) recipients. Thrombendarterectomy (TEA) of hypogastric artery was performed in 142 cases with subsequent anastomosis with the renal artery. Occlusion of hypogastric artery was an indication for renal graft artery to external iliac artery anastomosis in 32 patients. Atherosclerotic changes in external and common iliac artery required TEA in 25 patients and anastomosis between renal artery and external artery was performed. Ilio-iliac bypass or Y-graft simultaneously with kidney transplantation were performed in two cases. One-year survival rate of allografts and patients was 88% and 93%, respectively. No grafts were removed due to kidney artery thrombosis. We conclude that hypogastric artery after TEA provides adequate blood supply to kidney graft.
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ABSTRACT: The purpose of our study was to study the relevance of a systematic aorto-femoral colour Doppler ultrasound (DUS) in the evaluation of first renal transplant receivers. We prospectively studied 100 consecutive first renal transplant (RT) receivers. All patients had a preoperative physical examination with a careful vascular system evaluation including assessment of risk factors and colour DUS of aortic, iliac and femoral arteries. Renal transplantation was planned in the right iliac fossa with end-to-lateral vascular anastomoses. Clinical parameters, DUS results, operative and post-operative parameters at 3 months were compared according to the vascular assessment. Among the 84 patients presenting with a normal preoperative physical arterial examination, 12 patients (14.3%) had an abnormal DUS, revealing atherosclerotic arteries, but no case of arterial stenosis. Among the 16 patients with abnormal physical arterial examination, 10 patients (62.5%) had abnormal DUS, including 4 cases of iliac stenosis. In 3 of the 16 patients (18.8%), DUS revealed right iliac artery stenosis requiring a modification in the surgical procedure. No additional vascular procedure was reported in the case of normal preoperative vascular examination. No technical problems during arterial anastomosis and no post-transplantation arterial complications were reported. In multivariate analysis, abnormal physical examination was the most significant risk factor of atherosclerotic infiltration in DUS. The abnormality of arterial physical examination is the best clinical predictor of abnormal DUS in preoperative assessment of renal transplant receivers. However, the low sensitivity and positive predictive value of the physical examination do not support the conclusion that DUS can be avoided in patients with normal arterial physical examination. Nevertheless, in the case of arterial physical abnormality, 'for case' DUS is critical and helps in the surgical strategy in approximately 20% of cases.Nephrology Dialysis Transplantation 09/2009; 25(1):270-4. · 3.37 Impact Factor
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ABSTRACT: As the average age of a renal transplant candidate increases, the challenge of managing recipient vascular disease affecting renal allograft function will become more common. Pre-operative screening can reveal the presence of atheromatous disease that could adversely affect allograft transplantation and function, but parameters for successful screening have not been established. Treatment options include pre-operative revascularization, concurrent therapy or delayed revascularization. Endovascular therapies have burgeoned but surgical correction is still required for some of the more complex, long-segment lesions. Potential surgical interventions range from endarterectomy to aorto-iliac bypasses. We present a case of immediate post-operative revascularization using a femoro-femoral bypass to salvage a renal allograft. The literature is reviewed to assess best practices for detecting peripheral vascular disease in renal transplant candidates and subsequent management options.Clinical Transplantation 11/2010; 25(3):337-44. · 1.63 Impact Factor
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ABSTRACT: To report our experience of arterial anastomosis with Nakayama's ring pin staplers (titanium staplers) after an endarterectomy in kidney transplantation of diabetic recipients with iliac atherosclerosis. In a series of 2126 kidney transplantations carried out between January 1998 and December 2008, 62 recipients received an endarterectomy during transplantation before renal arterial anastomoses as a result of severe iliac atherosclerosis. The renal arteries were anatomosed to hypogastric arteries through titanium staplers in 32 patients (group 1), or to external/common iliac arteries with conventional suturing in 30 patients (group 2). Perioperative outcomes of the two groups have been compared. The mean artery anastomosis time in group 1 was considerably shorter than in the group 2 (6.4 min vs 17.3 min, P < 0.001). Group 1 showed a lower rate of delayed graft function (4.8% vs 27.5%, P = 0.004). No difference in Kaplan-Meier patient survival rate was found between group 1 and group 2 after follow up of 67 ± 28 months (P = 0.58). Graft survival rate (patient deaths included) was higher in group 1 than in group 2 (P = 0.04). Arterial anastomosis with a titanium stapler is more rapid than conventional suture. It can diminish the rate of delayed graft function and improve the graft survival rate in diabetic recipients with severe iliac atherosclerosis.International Journal of Urology 12/2011; 19(4):336-42. · 1.73 Impact Factor