title: Aortofemoral bypass to bridge end-stage renal disease patients with severe iliac calcification to kidney transplantation.
abstract: Patients undergoing hemodialysis have a lower survival rate than those who receive a kidney transplant. Mortality among hemodialysis patients is approximately 14.5% compared with 1.5% for transplant recipients. One of the exclusion criteria for renal transplant is severe iliac artery calcification. We performed an aortofemoral bypass in these patients to make them eligible for renal transplantation. Eleven patients were selected to receive an aortofemoral bypass. All had severe calcification of iliac arteries. Eight patients required a bypass from the thoracic aorta and two from the infrarenal level. Revascularization was successful in 10 patients. Patency was 100%. Surgery could not be performed in one owing to severe calcification of the femoral artery. One patient died owing to gastrointestinal bleeding. Two patients developed complications; one needed a splenectomy, and the other developed meningitis and paralytic ileus. To date, four patients have received transplants, and the viability of the transplanted kidney is good in all cases. Renal transplantation is the only method known to improve survival and quality of life for hemodialysis patients. We consider that if patients with severe iliac calcification are well informed of the morbidity and mortality risk of an aortic bypass, this intervention can be justified in this setting.
authors.affiliation: Department of Vascular Surgery, Sant Pau i Santa Creu Hospital, Barcelona, Spain. txell1108@hotmail.com
authors.forename: Meritxell
authors.initials: M
authors.lastname: Davins
authors.forename: Secundino
authors.initials: S
authors.lastname: Llagostera
authors.forename: Rocio
authors.initials: R
authors.lastname: Jimenez
authors.forename: Antonio
authors.initials: A
authors.lastname: Rosales
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Romero
authors.forename: Joan Manuel
authors.initials: JM
authors.lastname: Diaz
mesh_terms: D000368:Aged; D001011:Aorta / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000601:surgery*; D000075202:Contraindications; D005240:Feasibility Studies; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome