Consequences of iliac arterial atheroma on renal transplantation.
OBJECTIVE
Because recipient age has significantly increased in the last 15 years, surgeons must sometimes deal with atherosclerotic lesions of the iliac arterial system. Arterial restoration during renal transplantation should now be less frequent due to better preoperative screening and the prevention of arteriosclerosis in patients on renal transplantation waiting lists but in some patients EIA atheroma may require an additional surgical vascular procedure during renal transplantation. We describe the role of iliac artery atherosclerosis and the technical aspects of arterial restoration performed in patients who have undergone renal transplantation since 1985.


METHODS
In a series of 1,110 cadaveric renal transplantations performed between 1985 and 2000, 38 patients required endarterectomy during renal transplantation and 69 were considered not to require any special procedure.


RESULTS
In the 38 patients requiring endarterectomy a total of 12 end-to-end arterial anastomoses were performed and 6 ASs (50%) were observed, while 26 side-to-end arterial anastomoses were performed with only 1 AS (4%). Patient and graft survival curves showed a significant negative correlation with the severity of atherosclerosis.


CONCLUSIONS
Preoperative assessment of the EIA is mandatory before renal transplantation. Renal transplantation can be performed in patients with an atheromatous EIA if the artery can be clamped for endarterectomy. In our experience side-to-end anastomosis using a donor patch onto the EIA provides better results by avoiding AS after endarterectomy. However, despite vascular repair graft survival is significantly lower in patients with atheromatous lesions requiring endarterectomy.
Department of Urology, Hospital de Bicêtre, University Paris Sud, Le Kremlin-Bicêtre, France. sdroupy@aol.com
Stéphane
S
Droupy
Pascal
P
Eschwège
Yacine
Y
Hammoudi
Antoine
A
Durrbach
Bernard
B
Charpentier
Gérard
G
Benoit
D000328:Adult; D050197:Atherosclerosis / Q000601:surgery; D006085:Graft Survival; D006801:Humans; D007083:Iliac Artery; D016030:Kidney Transplantation; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors