title: Management of peripheral vascular disease compromising renal allograft placement and function: review of the literature with an illustrative case.
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.
authors.affiliation: Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. gillr@upmc.edu
authors.forename: Roop
authors.initials: R
authors.lastname: Gill
authors.forename: Ron
authors.initials: R
authors.lastname: Shapiro
authors.forename: Liise K
authors.initials: LK
authors.lastname: Kayler
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007676:Kidney Failure, Chronic / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000628:therapy*; D011379:Prognosis; D006435:Renal Dialysis; D012196:Review Literature as Topic; D016559:Tacrolimus / Q000009:adverse effects; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus