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Kidney transplantation in recipients with atherosclerotic iliac vessels
Z Gałazka1, J Szmidt, S Nazarewski
1Department of Vascular Surgery and Transplantology, Medical University of Warsaw, Poland.
Abstract:
The influence of atherosclerotic lesions of hypogastric and iliac arteries of kidney recipients on intraoperative surgical technique and one-year graft and patient survival was investigated. Among 1553 transplanted kidneys atherosclerotic lesions which required surgical intervention were found in 201 (12.9%) recipients. Thrombendarterectomy (TEA) of hypogastric artery was performed in 142 cases with subsequent anastomosis with the renal artery. Occlusion of hypogastric artery was an indication for renal graft artery to external iliac artery anastomosis in 32 patients. Atherosclerotic changes in external and common iliac artery required TEA in 25 patients and anastomosis between renal artery and external artery was performed. Ilio-iliac bypass or Y-graft simultaneously with kidney transplantation were performed in two cases. One-year survival rate of allografts and patients was 88% and 93%, respectively. No grafts were removed due to kidney artery thrombosis. We conclude that hypogastric artery after TEA provides adequate blood supply to kidney graft.
Insights
Kidney transplant recipients with atherosclerotic lesions in hypogastric and iliac arteries can undergo successful surgical interventions. These procedures, including thrombendarterectomy (TEA), support good one-year graft and patient survival rates.
Area of Science:
- Vascular Surgery
- Nephrology
- Transplantation Medicine
Background:
- Atherosclerotic lesions in the hypogastric and iliac arteries pose challenges in kidney transplantation.
- Assessing the impact of these lesions on surgical techniques and outcomes is crucial.
Purpose of the Study:
- To investigate the influence of atherosclerotic lesions in hypogastric and iliac arteries on intraoperative surgical technique.
- To evaluate the one-year graft and patient survival rates in kidney recipients with these vascular conditions.
Main Methods:
- Retrospective analysis of 1553 kidney transplant recipients.
- Identification of 201 (12.9%) recipients with atherosclerotic lesions requiring surgical intervention.
- Description of surgical techniques: thrombendarterectomy (TEA), renal artery to external iliac artery anastomosis, ilio-iliac bypass, and Y-graft.
Main Results:
- TEA of the hypogastric artery was performed in 142 cases.
- Renal graft artery to external iliac artery anastomosis was used in 32 cases.
- One-year allograft survival was 88%, and patient survival was 93%.
- No graft loss due to renal artery thrombosis was reported.
Conclusions:
- Surgical management of atherosclerotic lesions in hypogastric and iliac arteries is feasible in kidney transplantation.
- Thrombendarterectomy of the hypogastric artery ensures adequate blood supply to the kidney graft.
- The applied surgical techniques are associated with favorable one-year graft and patient survival outcomes.