title: Aortic reconstruction in patients with functioning renal allografts.
abstract: Patients with functioning renal allografts requiring aortic reconstruction pose a considerable challenge to the vascular surgeon. A variety of strategies for renal allograft preservation during intervention have been described including hypothermia, indwelling shunts, cold renal perfusion, axillofemoral bypass, and endovascular stent-grafting. Reported here are two cases of successful aortic reconstruction utilizing standard open surgical techniques designed simply to minimize warm renal ischemia. The first case was that of a 55 year-old patient with a functional renal allograft originating from the right external iliac artery, who presented acutely with large symptomatic aortic and bilateral iliac artery aneurysms. He was treated with aorto-right femoral/left iliac bypass grafting. The right femoral anastomosis was performed first so that warm renal ischemia was limited to the 34 min required to perform the proximal end-to-end aortic anastomosis. The second case was that of a 44-year-old patient also with a transplanted kidney originating from the right external iliac artery. He presented with worsening hypertension, decreasing renal function, claudication, and severe aortoiliac occlusive disease. He was treated with aorto-left femoral bypass grafting via a retroperitoneal approach, followed by femorofemoral crossover bypass for retrograde perfusion of the kidney (total warm ischemia time 20 min). Both patients recovered uneventfully without a decrement in renal function and remain well on follow-up. It is concluded that standard open surgery without adjunctive shunts or bypasses remains a viable treatment option for these patients, provided warm renal ischemia can be minimized.
authors.affiliation: Section of Vascular Surgery MC 5028, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Skelly
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Farmer
authors.forename: Michael A
authors.initials: MA
authors.lastname: Curi
authors.forename: Shari L
authors.initials: SL
authors.lastname: Meyerson
authors.forename: Roy S
authors.initials: RS
authors.lastname: Davidovitch
authors.forename: David H
authors.initials: DH
authors.lastname: Woo
authors.forename: Lewis B
authors.initials: LB
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D006801:Humans; D017543:Iliac Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015607:Stents; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures