J Korean Surg Soc.  2013 Mar;84(3):189-193.

Endovascular abdominal aortic aneurysm repair in patients with renal transplant

• Joh JH
• Nam DH
• Park HC

Abstract

The repair of abdominal aortic aneurysm (AAA) in patients with functioning renal transplant is critical because it is important to avoid ischemic and reperfusion injury to the transplanted kidney. Endovascular aneurysm repair (EVAR) avoids aortic cross clamping and can prevent renal graft ischemia. Here we report the endovascular management and outcome of AAA in two renal transplant patients using a bifurcated aortic stent graft. One patient underwent EVAR using a small amount of contrast (30 mL) due to decreased renal function resulting from chronic rejection. Another patient had EVAR performed with iliac conduit because of the heavily calcified, stenotic lesion of external iliac artery. EVAR in patients with a renal transplant is a feasible option without impairing renal arterial flow.

Keyword

Abdominal aortic aneurysm; Kidney transplantation; Endovascular procedures

MeSH Terms

Aneurysm
Aortic Aneurysm, Abdominal
Constriction
Endovascular Procedures
Humans
Iliac Artery
Ischemia
Kidney
Kidney Transplantation
Rejection (Psychology)
Reperfusion Injury
Stents
Transplants

Figure

• 

  Fig. 1 Patient I: coronal view of preoperative computed tomography (CT) scan and endovascular procedure. (A) Preoperative, nonenhanced CT scan showed the calcified abdominal aortic aneurysm (open arrow) and transplanted kidney in right lower abdomen (white arrow). (B) The type Ib endoleak (open arrow) was seen at the right distal landing zone after placement of stent-graft. The renal artery of transplanted kidney arose from the right internal iliac artery (black arrow). (C) Final angiogram showed the disappearance of endoleak and well perfused transplanted kidney.

• 

  Fig. 2 Patient II: preoperative and postoperative computed tomography angiography (CTA). (A) The maximal intensity projection view of preoperative CTA showed the abdominal aortic aneurysm (white arrow), the renal artery of functioning transplanted kidney originated right internal iliac artery (curved arrow), and heavily calcified left external iliac artery (open arrow). (B) The volume rendering view of postoperative CTA showed no endoleak and well perfused transplanted kidney.

• 

  Fig. 3 Iliac conduit. (A) The iliac conduit was created on left iliac bifurcation using 10 mm Dacrongraft. (B) There are two introducer sheaths, distal one (black arrow) for angiography and proximal one (open arrow) for the delivery of a main stent-graft.

• 

  Fig. 4 Brachial approach and snaring of the guidewire. (A) There is the angiographic catheter passed through left brachial artery (black arrow). (B) The successful snaring was done for the cannulation of contralateral gate (open arrow).

Reference

1. Karkos CD, McMahon G, Fishwick G, Lambert K, Bagga A, McCarthy MJ. Endovascular abdominal aortic aneurysm repair in the presence of a kidney transplant: therapeutic considerations. Cardiovasc Intervent Radiol. 2006. 29:284–288.

2. Kim HK, Ryuk JP, Choi HH, Kwon SH, Huh S. Abdominal aortic aneurysm repair in patient with a renal allograft: a case report. J Korean Med Sci. 2009. 24:166–169.

3. Machado R, Almeida P, Loureiro L, Almeida R. Renal transplantation after endovascular aortic aneurysm repair: case report and literature review. Transplant Proc. 2011. 43:150–152.

4. Hseino H, McGrath F, Hickey D, Hill AD, Moneley D. Endovascular abdominal aortic aneurysm repair in kidney transplant recipients: case series. Surgeon. 2011. 9:115–117.

5. Kaskarelis IS, Koukoulaki M, Lappas I, Karkatzia F, Dimopoulos N, Filias V, et al. Successful endovascular repair of ruptured abdominal aortic aneurysm in a renal transplant recipient. Cardiovasc Intervent Radiol. 2006. 29:279–283.

6. Sawhney R, Chuter TA, Wall SD, Reilly LM, Kerlan RK, Canto CJ, et al. Aortic stent-grafts in patients with renal transplants. J Endovasc Ther. 2000. 7:286–291.

7. Lacombe M. Surgical treatment of aortoiliac aneurysms in renal transplant patients. J Vasc Surg. 2008. 48:291–295.

8. Leon LR Jr, Glazer ES, Hughes JD, Bui TD, Psalms SB, Goshima KR. Aortoiliac aneurysm repair in kidney transplant recipients. Vasc Endovascular Surg. 2009. 43:30–45.

9. Roach DM, Thompson MM, Patrick GM, Fitridge RA. Aortic aneurysm repair with a functioning renal transplant: therapeutic options. ANZ J Surg. 2004. 74:65–67.

10. Criado FJ. Iliac arterial conduits for endovascular access: technical considerations. J Endovasc Ther. 2007. 14:347–351.