Transplant Renal Artery Stenosis Revascularization: Common Distal External Iliac Bypass
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.
22 September 2020 (online)
Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.
- 1 Gill R, Shapiro R, Kayler LK. Management of peripheral vascular disease compromising renal allograft placement and function: review of the literature with an illustrative case. Clin Transplant 2011; 25 (03) 337-344
- 2 Becker BN, Odorico JS, Becker YT. , et al. Peripheral vascular disease and renal transplant artery stenosis: a reappraisal of transplant renovascular disease. Clin Transplant 1999; 13 (04) 349-355
- 3 Bruno S, Remuzzi G, Ruggenenti P. Transplant renal artery stenosis. J Am Soc Nephrol 2004; 15 (01) 134-141
- 4 Brekke IB, Lien B, Sødal G. , et al. Aortoiliac reconstruction in preparation for renal transplantation. Transpl Int 1993; 6 (03) 161-163
- 5 Baxter GM. Ultrasound of renal transplantation. Clin Radiol 2001; 56 (10) 802-818
- 6 O'Hare AM, Rodriguez RA, Bacchetti P. Low ankle-brachial index associated with rise in creatinine level over time: results from the atherosclerosis risk in communities study. Arch Intern Med 2005; 165 (13) 1481-1485
- 7 Langsfeld M, Nepute J, Hershey FB. , et al. The use of deep duplex scanning to predict hemodynamically significant aortoiliac stenoses. J Vasc Surg 1988; 7 (03) 395-399
- 8 Suthanthiran M, Strom TB. Renal transplantation. N Engl J Med 1994; 331 (06) 365-376
- 9 Voiculescu A, Hollenbeck M, Plum J. , et al. Iliac artery stenosis proximal to a kidney transplant: clinical findings, duplex-sonographic criteria, treatment, and outcome. Transplantation 2003; 76 (02) 332-339
- 10 Turunç V, Eroğlu A, Tabandeh B. , et al. Femoro-femoral bypass for graft salvage in a renal transplant patient with aorto-iliac occlusion: a case report. Transplant Proc 2015; 47 (05) 1511-1514
- 11 Ortiz CC, Miyara SJ, Cagliani JA, Cho YM, Guevara S, Hayashida K, Krishnasastry KV. Renal Transplant Artery Inflow Stenosis Treated with Femorofemoral Bypass. Int J Angiol 2020