title: Utilization of vascular conduits to facilitate renal transplantation in patients with significant aortoiliac calcification.
abstract: OBJECTIVE
  To describe the use of vascular conduits (donor iliac artery or saphenous vein) in renal transplantation recipients with extensive aortoiliac calcification.
  
  
  METHODS
  Vascular conduits were used in 10 renal transplants with severe vascular calcification at Cleveland Clinic from 2009 to 2013. Both iliac artery (N = 8) and saphenous vein (N = 2) grafts were used. Surgical technique is reviewed in detail. Surgical complications, patency on renal transplant ultrasonography, and serum creatinine level at multiple time points were reviewed.
  
  
  RESULTS
  Mean follow-up time was 26 months (7-44 months). Mean serum creatinine level was 1.42 mg/dL (1.04-1.74 mg/dL) at 6 months, 1.35 mg/dL (0.83-1.86 mg/dL) at 12 months, and 1.43 mg/dL (0.79-1.81 mg/dL) at last follow-up. All patients were demonstrated postoperatively to have patent vasculature on renal ultrasonography. No patients experienced lower extremity vascular complications. Death-censored graft survival was 100%. One patient died from complications after mitral valve replacement, and one patient died from metastatic squamous cell carcinoma of the tongue. Both patients had functioning grafts at the time of death.
  
  
  CONCLUSIONS
  Vascular conduits can be used to facilitate renal transplantation in the setting of severe recipient aortoiliac calcification, thus allowing for successful transplantation of these complex recipients.
authors.affiliation: Division of Kidney and Pancreas Transplantation, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH. Electronic address: colemas2@ccf.org.
authors.forename: Sarah
authors.initials: S
authors.lastname: Coleman
authors.affiliation: Division of Kidney and Pancreas Transplantation, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Hannah
authors.initials: H
authors.lastname: Kerr
authors.affiliation: Division of Kidney and Pancreas Transplantation, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: David
authors.initials: D
authors.lastname: Goldfarb
authors.affiliation: Division of Kidney and Pancreas Transplantation, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Krishnamurthi
authors.affiliation: Division of Kidney and Pancreas Transplantation, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: John C
authors.initials: JC
authors.lastname: Rabets
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000637:transplantation*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D012720:Severity of Illness Index; D061205:Vascular Calcification / Q000601:surgery*; D058017:Vascular Grafting