Int J Angiol
DOI: 10.1055/s-0040-1714663
Case Report

Transplant Renal Artery Stenosis Revascularization: Common Distal External Iliac Bypass

Santiago J. Miyara
1  Department of Surgery, Northwell Health, Manhasset, New York, USA
2  Department of Emergency Medicine, Northwell Health, Manhasset, New York, USA
3  Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, USA
4  Feinstein Institutes for Medical Research, Manhasset, New York, USA
,
Christopher C. Ortiz
1  Department of Surgery, Northwell Health, Manhasset, New York, USA
,
Sara Guevara
1  Department of Surgery, Northwell Health, Manhasset, New York, USA
,
Alexia Molmenti
1  Department of Surgery, Northwell Health, Manhasset, New York, USA
,
Gerardo Tamayo-Enriquez
1  Department of Surgery, Northwell Health, Manhasset, New York, USA
,
Young Min Cho
1  Department of Surgery, Northwell Health, Manhasset, New York, USA
,
Joaquin A. Cagliani
1  Department of Surgery, Northwell Health, Manhasset, New York, USA
3  Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, USA
,
Jorge Molinas
1  Department of Surgery, Northwell Health, Manhasset, New York, USA
,
Kei Hayashida
2  Department of Emergency Medicine, Northwell Health, Manhasset, New York, USA
4  Feinstein Institutes for Medical Research, Manhasset, New York, USA
,
Koichiro Shinozaki
2  Department of Emergency Medicine, Northwell Health, Manhasset, New York, USA
4  Feinstein Institutes for Medical Research, Manhasset, New York, USA
,
Ryosuke Takegawa
2  Department of Emergency Medicine, Northwell Health, Manhasset, New York, USA
4  Feinstein Institutes for Medical Research, Manhasset, New York, USA
,
K. V. Krishnasastry
1  Department of Surgery, Northwell Health, Manhasset, New York, USA
,
Lance B. Becker
2  Department of Emergency Medicine, Northwell Health, Manhasset, New York, USA
3  Elmezzi Graduate School of Molecular Medicine, Manhasset, New York, USA
4  Feinstein Institutes for Medical Research, Manhasset, New York, USA
,
Ernesto P. Molmenti
1  Department of Surgery, Northwell Health, Manhasset, New York, USA
2  Department of Emergency Medicine, Northwell Health, Manhasset, New York, USA
4  Feinstein Institutes for Medical Research, Manhasset, New York, USA
› Author Affiliations

Abstract

Stenosis proximal to transplant renal artery anastomoses are complications leading to allograft dysfunction. This study was aimed to evaluate a novel surgical approach to renal allograft revascularization, taking into consideration the length of time elapsed since transplantation. We describe an arterial bypass using a polytetrafluoroethylene (PTFE) graft from the common iliac artery (proximal to the renal artery implantation) to the external iliac artery (distal to the renal artery implantation) that allows the adequate revascularization of both the transplant kidney, as well as the lower extremity. This technique provides several advantages when compared with previously described procedures to revascularize a transplanted kidney with an iliac artery stenosis proximal to the allograft implantation site. Benefits of this technique include (1) no need to repair the stenosis, (2) no need to take down and redo the arterial anastomosis, (3) no need to perform a dissection around the renal hilum of the transplanted kidney, (4) no requirement to address the anastomosis transfer, and (5) no need to perfuse the kidney with preservation fluid at the time of repair and/or (6) avoidance of potential injury to the renal parenchyma and/or hilum during dissections. Adequate perfusion of the organ, as well as of the lower extremity was verified by serial Doppler duplex ultrasound evaluations. Hence, we describe a novel revascularization technique in instances of kidney transplant and lower extremity ischemia.

Both authors contributed equally to the article.




Publication History

Publication Date:
22 September 2020 (online)

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