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Abdominal aortic aneurysm repair in patient with a renal allograft: a case report.

Kim HK, Ryuk JP, Choi HH, Kwon SH, Huh S - J. Korean Med. Sci. (2009)

Bottom Line: A variety of strategies for protection of the renal allograft during AAA intervention have been described including a temporary shunt, cold renal perfusion, extracorporeal bypass, general hypothermia, and endovascular stent-grafting.We treated a case of AAA in a patient with a renal allograft using a temporary aortofemoral shunt with good result.Since this technique is safe and effective, it should be considered in similar patients with AAA and previously placed renal allografts.

View Article: PubMed Central - PubMed

Affiliation: Division of Transplantation and Vascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, Korea.

ABSTRACT
Renal transplant recipients requiring aortic reconstruction due to abdominal aortic aneurysm (AAA) pose a unique clinical problem. The concern during surgery is causing ischemic injury to the renal allograft. A variety of strategies for protection of the renal allograft during AAA intervention have been described including a temporary shunt, cold renal perfusion, extracorporeal bypass, general hypothermia, and endovascular stent-grafting. In addition, some investigators have reported no remarkable complications of the renal allograft without any specific measures. We treated a case of AAA in a patient with a renal allograft using a temporary aortofemoral shunt with good result. Since this technique is safe and effective, it should be considered in similar patients with AAA and previously placed renal allografts.

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Related in: MedlinePlus

Temporary aortofemoral shunt from the perirenal aorta to the right femoral artery, allowing perfusion of the pelvic renal allograft during aortic cross-clamping.
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Figure 2: Temporary aortofemoral shunt from the perirenal aorta to the right femoral artery, allowing perfusion of the pelvic renal allograft during aortic cross-clamping.

Mentions: After one month of medical management, he underwent an AAA repair with a tube prosthesis and a temporary aortofemoral shunt. Through a transperitoneal approach, the aorta was dissected up to the renal artery without renal vein division. A separate right groin incision was made to expose the common femoral artery. Because the proximal neck of his AAA was enough to place the temporary shunt, cannulation for a temporary shunt was performed at the level of the perirenal aorta; this shunt was placed in the common femoral artery (Fig. 2). A 16-Fr and a 12-Fr aortic perfusion cannula (Edwards Lifesciences, Irvine, CA, U.S.A.) were used for the temporary shunt, and these two cannulas were connected with a 3/8" connector. After confirming this temporary shunt's function, we performed infrarenal aortic cross-clamping. The total aortic cross-clamping time was 34 min and the renal allograft produced urine throughout the AAA repair with a 16-mm Dacron tube graft. The aortic and femoral cannulation sites were simply closed with previously placed purse-string sutures. The patient recovered without any complications, and the immediate postoperative serum creatinine level was 1.1 mg/dL. During the admission, his serum creatinine level remained within normal limits. He was discharged after a 14-day hospitalization, and subsequent CT angiographic images showed a well-functioning aortic graft with a renal allograft (Fig. 3). His renal function has remained stable over 18 months of follow-up.


Abdominal aortic aneurysm repair in patient with a renal allograft: a case report.

Kim HK, Ryuk JP, Choi HH, Kwon SH, Huh S - J. Korean Med. Sci. (2009)

Temporary aortofemoral shunt from the perirenal aorta to the right femoral artery, allowing perfusion of the pelvic renal allograft during aortic cross-clamping.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2651000&req=5

Figure 2: Temporary aortofemoral shunt from the perirenal aorta to the right femoral artery, allowing perfusion of the pelvic renal allograft during aortic cross-clamping.
Mentions: After one month of medical management, he underwent an AAA repair with a tube prosthesis and a temporary aortofemoral shunt. Through a transperitoneal approach, the aorta was dissected up to the renal artery without renal vein division. A separate right groin incision was made to expose the common femoral artery. Because the proximal neck of his AAA was enough to place the temporary shunt, cannulation for a temporary shunt was performed at the level of the perirenal aorta; this shunt was placed in the common femoral artery (Fig. 2). A 16-Fr and a 12-Fr aortic perfusion cannula (Edwards Lifesciences, Irvine, CA, U.S.A.) were used for the temporary shunt, and these two cannulas were connected with a 3/8" connector. After confirming this temporary shunt's function, we performed infrarenal aortic cross-clamping. The total aortic cross-clamping time was 34 min and the renal allograft produced urine throughout the AAA repair with a 16-mm Dacron tube graft. The aortic and femoral cannulation sites were simply closed with previously placed purse-string sutures. The patient recovered without any complications, and the immediate postoperative serum creatinine level was 1.1 mg/dL. During the admission, his serum creatinine level remained within normal limits. He was discharged after a 14-day hospitalization, and subsequent CT angiographic images showed a well-functioning aortic graft with a renal allograft (Fig. 3). His renal function has remained stable over 18 months of follow-up.

Bottom Line: A variety of strategies for protection of the renal allograft during AAA intervention have been described including a temporary shunt, cold renal perfusion, extracorporeal bypass, general hypothermia, and endovascular stent-grafting.We treated a case of AAA in a patient with a renal allograft using a temporary aortofemoral shunt with good result.Since this technique is safe and effective, it should be considered in similar patients with AAA and previously placed renal allografts.

View Article: PubMed Central - PubMed

Affiliation: Division of Transplantation and Vascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, Korea.

ABSTRACT
Renal transplant recipients requiring aortic reconstruction due to abdominal aortic aneurysm (AAA) pose a unique clinical problem. The concern during surgery is causing ischemic injury to the renal allograft. A variety of strategies for protection of the renal allograft during AAA intervention have been described including a temporary shunt, cold renal perfusion, extracorporeal bypass, general hypothermia, and endovascular stent-grafting. In addition, some investigators have reported no remarkable complications of the renal allograft without any specific measures. We treated a case of AAA in a patient with a renal allograft using a temporary aortofemoral shunt with good result. Since this technique is safe and effective, it should be considered in similar patients with AAA and previously placed renal allografts.

Show MeSH
Related in: MedlinePlus