title: Treatment of aortoiliac occlusive or dilatative disease concomitant with kidney transplantation: how and when?
abstract: OBJECTIVE
  Aortoiliac (AI) lesions (both dilatative and occlusive) can occur in kidney allograft recipients. The correct timing of vascular imaging and treatment is controversial. Aim of the present paper is to report our experience.
  
  
  METHODS
  between January 2010 and December 2012, 106 patients included in our waiting list for kidney transplant underwent computed tomography (CT) angiogram to study AI axis. In 21 cases an AI lesion was identified before transplant. In 3 cases surgery was mandatory before kidney transplant, and in 18 cases lesions were treated simultaneously with kidney transplantation.
  
  
  RESULTS
  AI pathology distribution was as follows: 15 iliac stenoses treated with thromboendarterectomy (TEA), 2 Leriche syndrome and 1 aortic aneurism treated with an aortobisiliac bypass (AI-BP), and 3 aneurysms treated with endovascular aortic repair (EVAR). In two cases a postoperative hematoma occurred. In one case occlusion of a stent-graft branch was treated with a femoro-femoral crossover bypass and transplant was then performed on the contralateral iliac axis. Perioperative mortality was 0%, and graft survival rate was 100% at 1 year in all cases.
  
  
  CONCLUSIONS
  A CT angiogram is useful in order to detect AI lesions and to be able to evaluate the best treatment option for the kidney transplantation and the correct timing for additional vascular surgery. The EVAR procedure should be safe, and does not compromise anastomosis success and graft survival, with less postoperative complications than open surgery.
authors.affiliation: Unit of General Surgery and Organ Transplantation, Insubria University, Varese, Italy; Unit of Vascular Surgery, Insubria University, Varese, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Tozzi
authors.affiliation: Unit of General Surgery and Organ Transplantation, Insubria University, Varese, Italy; Unit of General Surgery, Insubria University, Varese, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Franchin
authors.affiliation: Unit of General Surgery and Organ Transplantation, Insubria University, Varese, Italy; Unit of General Surgery, Insubria University, Varese, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Soldini
authors.affiliation: Unit of General Surgery and Organ Transplantation, Insubria University, Varese, Italy; Unit of General Surgery, Insubria University, Varese, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ietto
authors.affiliation: Unit of General Surgery and Organ Transplantation, Insubria University, Varese, Italy; Unit of Vascular Surgery, Insubria University, Varese, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Chiappa
authors.affiliation: Unit of General Surgery and Organ Transplantation, Insubria University, Varese, Italy; Unit of General Surgery, Insubria University, Varese, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Molteni
authors.affiliation: Unit of General Surgery and Organ Transplantation, Insubria University, Varese, Italy; Unit of General Surgery, Insubria University, Varese, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Amico
authors.affiliation: Unit of General Surgery and Organ Transplantation, Insubria University, Varese, Italy; Unit of General Surgery, Insubria University, Varese, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Carcano
authors.affiliation: Unit of General Surgery, Insubria University, Varese, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Dionigi
mesh_terms: D001011:Aorta / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D004691:Endarterectomy / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged
keywords: Kidney transplant Aortic aneurism Aortoiliac stenosis Endarterectomy EVAR; Leriche syndrome