Aortoiliac surgery concomitant with kidney  transplantation: a single center experience.
BACKGROUND
Aortoiliac pathology in kidney allograft recipients is not rare but treatment timing is controversial. As most publications on this topic are case reports its difficult to evaluate long-term outcomes of those clinical challenges. Herein we report long-term results of these procedures.


METHODS
From 1970 to 2006, 1544 kidney transplants were performed in our center. Thirty patients underwent aortoiliac surgery simultaneously with kidney transplantation. We analyzed their clinical records to come up with outcomes of these complex clinical challenges.


RESULTS
Vascular pathology was distributed as following: 19 stenoses treated with endarterectomy (15), aortoiliac bypass (two), aorto-bi-iliac bypass (one) and aorto-bifemoral bypass (one); and 11 aneurysms treated with arterioplasty (four), aorto-bi-iliac bypass (four) and iliac-iliac bypass (three). In 24 cases (80%) the necessity of vascular surgery was established intraoperatively as vessels conditions did not permit safe anastomoses and jeopardized graft survival. Mean follow-up was 59 months (12-125). Five (16.7%) grafts were lost and three (10%) patients died in the first postoperative month: acute myocardial infarction (two) and non-viable kidney (one). Three patients died six, seven and 10 yr after the procedure. Nineteen patients are currently well with functioning grafts.


CONCLUSIONS
Surgical correction of aortoiliac pathology may be performed simultaneously with kidney transplantation with acceptable outcome. This complex surgery can be performed in centers with experienced vascular surgeons. Specific vascular imaging should be performed regularly on patient at risk of aortoiliac disease before insertion and while on waiting list.
Tsivian
Matvey
M
Department of General Surgery and Transplantations, Kidney Transplantation Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. mtsivian@hotmail.com
Neri
Flavia
F
Nardo
Bruno
B
Bertelli
Riccardo
R
Cavallari
Giuseppe
G
Fuga
Giovanni
G
Faenza
Alessandro
A
D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal / Q000473:pathology / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D005260:Female; D005921:Glomerulonephritis / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000473:pathology / Q000601:surgery*; D007431:Intraoperative Complications; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome