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Kidney transplantation in a patient with absent right common iliac artery and congenital renal abnormalities.

Tay CM, Siew EP, Ng TK, Vathsala A, Tiong HY - Int J Surg Case Rep (2015)

Bottom Line: Congenital atresia of the common and external iliac arteries is a rare vascular anomaly that may be associated with congenital renal or genitourinary malformations.While most cases of congenital iliac artery anomalies are symptomatic with claudication, some remain asymptomatic with normal physical examination findings.There is some evidence in literature suggesting the usefulness of routine pre-operative CT in a selective group of patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, National University Health System, Singapore.

No MeSH data available.


Related in: MedlinePlus

Intra-operative image of the left external and internal iliac arteries, as well as the preserved anomalous vessel branching off the internal iliac artery.
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fig0015: Intra-operative image of the left external and internal iliac arteries, as well as the preserved anomalous vessel branching off the internal iliac artery.

Mentions: Despite the vascular abnormalities detected on radiological imaging, the patient was asymptomatic. He had no evidence of limb ischemia and pulses were symmetrical bilaterally in the lower limbs. He subsequently underwent LRRT with implantation of kidney performed in the left iliac fossa. Intra-operatively, dissection of the left iliac vessels clearly demonstrated the anomalous vessel branching off the left internal iliac artery and this was carefully preserved (Fig. 3). The renal artery and vein were anastomosed end-to side to the left external iliac artery and vein, respectively, a significant distance distal to the origin of the anomalous vessel. Ureteral anastomosis was performed to the augmented colonic cystoplasty. Good perfusion to the kidney was observed after vascular clamps were released and bilateral dorsalis pedis pulses were palpable intra-operatively. Post-operatively, the patient did not develop any signs or symptoms of limb ischemia and was able to ambulate without difficulty. Mercaptoacetyltriglycine-3 (MAG-3) and ultrasound scans showed prompt perfusion to the transplant kidney with normal flow velocities and Doppler waveforms (Fig. 4). There was immediate graft function and renal function recovered quickly with good urine output. The patient made an uneventful recovery and was discharged home on post-operative day 12 with a creatinine of 103 μmol/L. Subsequent outpatient follow-up within the first postoperative year did not reveal any features of lower limb ischemia. His graft function also remained stable on an immunosuppression regime consisting of Prednisolone, Azathioprine and Tacrolimus. He did require a reduction in Tacrolimus dose due to an episode primary Cytomegalovirus infection that was treated successfully with valgancyclovir.


Kidney transplantation in a patient with absent right common iliac artery and congenital renal abnormalities.

Tay CM, Siew EP, Ng TK, Vathsala A, Tiong HY - Int J Surg Case Rep (2015)

Intra-operative image of the left external and internal iliac arteries, as well as the preserved anomalous vessel branching off the internal iliac artery.
© Copyright Policy - CC BY-NC-SA
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4430136&req=5

fig0015: Intra-operative image of the left external and internal iliac arteries, as well as the preserved anomalous vessel branching off the internal iliac artery.
Mentions: Despite the vascular abnormalities detected on radiological imaging, the patient was asymptomatic. He had no evidence of limb ischemia and pulses were symmetrical bilaterally in the lower limbs. He subsequently underwent LRRT with implantation of kidney performed in the left iliac fossa. Intra-operatively, dissection of the left iliac vessels clearly demonstrated the anomalous vessel branching off the left internal iliac artery and this was carefully preserved (Fig. 3). The renal artery and vein were anastomosed end-to side to the left external iliac artery and vein, respectively, a significant distance distal to the origin of the anomalous vessel. Ureteral anastomosis was performed to the augmented colonic cystoplasty. Good perfusion to the kidney was observed after vascular clamps were released and bilateral dorsalis pedis pulses were palpable intra-operatively. Post-operatively, the patient did not develop any signs or symptoms of limb ischemia and was able to ambulate without difficulty. Mercaptoacetyltriglycine-3 (MAG-3) and ultrasound scans showed prompt perfusion to the transplant kidney with normal flow velocities and Doppler waveforms (Fig. 4). There was immediate graft function and renal function recovered quickly with good urine output. The patient made an uneventful recovery and was discharged home on post-operative day 12 with a creatinine of 103 μmol/L. Subsequent outpatient follow-up within the first postoperative year did not reveal any features of lower limb ischemia. His graft function also remained stable on an immunosuppression regime consisting of Prednisolone, Azathioprine and Tacrolimus. He did require a reduction in Tacrolimus dose due to an episode primary Cytomegalovirus infection that was treated successfully with valgancyclovir.

Bottom Line: Congenital atresia of the common and external iliac arteries is a rare vascular anomaly that may be associated with congenital renal or genitourinary malformations.While most cases of congenital iliac artery anomalies are symptomatic with claudication, some remain asymptomatic with normal physical examination findings.There is some evidence in literature suggesting the usefulness of routine pre-operative CT in a selective group of patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, National University Health System, Singapore.

No MeSH data available.


Related in: MedlinePlus