title: Does kidney transplantation to iliac artery deteriorate ischemia in the ipsilateral lower extremity with peripheral arterial disease?
abstract: OBJECTIVE
  This study was conducted to investigate the progression of lower extremity ischemia following kidney transplantation to iliac artery in patients with peripheral arterial disease.
  
  
  METHODS
  A retrospective chart review of all renal transplant patients completed at a university teaching medical center from January 2006 to December of 2011 was performed. A total of 219 patients underwent successful kidney transplantation to the common, external, or internal iliac artery. Pre- and post-transplantation ischemic changes in the ipsilateral lower extremity were reviewed and analyzed.
  
  
  RESULTS
  Thirty-eight of the 219 patients had ipsilateral peripheral arterial disease and seven of them were symptomatic. Six of the seven symptomatic patients remained stable and one patient's rest pain improved, postoperatively. Eight patients developed new symptoms of ischemia 12 months later, including four with claudication, two with ischemic ulcers, and two with gangrene toes. The ulcers were healed following superficial femoral artery stenting and wound care. Toe amputation was performed in two patients with gangrene. No major amputation was required up to 48 months of follow-up.
  
  
  CONCLUSIONS
  Transplanted kidney to iliac artery does not significantly deteriorate ischemia in adults with ipsilateral lower extremity peripheral arterial disease. Late developed ischemic complications may be due to the progression of underlying arterial disease.
authors.affiliation: Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Northcutt
authors.affiliation: Department of Surgery, Willis Knighton Health System, Shreveport, LA, USA.
authors.forename: Gazi
authors.initials: G
authors.lastname: Zibari
authors.affiliation: Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors.forename: Tze-Woei
authors.initials: TW
authors.lastname: Tan
authors.affiliation: Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
authors.forename: Amy H
authors.initials: AH
authors.lastname: Coulter
authors.affiliation: Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA wzhan2@lsuhsc.edu.
authors.forename: Wayne W
authors.initials: WW
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D018450:Disease Progression; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007083:Iliac Artery / Q000503:physiopathology / Q000601:surgery*; D007511:Ischemia / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008145:Louisiana; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Lower extremity ischemia; kidney transplantation; peripheral arterial disease