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Iliac artery ligation: the relative paucity of ischemic sequelae in renal transplant patients
Insights
Iliac artery ligation during renal transplantation for hemorrhage control rarely leads to limb loss. Most patients regain ambulatory status, with few requiring later surgery for claudication.
Area of Science:
- Vascular Surgery
- Nephrology
- Transplantation Medicine
Background:
- Assessing the impact of iliac artery ligation on distal extremities is crucial in renal transplantation.
- Hemorrhage from infected arteriotomy sites can necessitate iliac artery ligation.
Observation:
- A review of 467 renal transplant procedures (390 patients) identified six cases of common and/or external iliac artery ligation.
- These cases were analyzed for ischemic sequelae in the affected leg.
Findings:
- No immediate deaths or limb loss occurred.
- Four of six patients regained ambulatory status; two later required elective reconstruction for claudication.
- A combined total of 14 patients (including prior reports) showed no limb loss, with only three needing subsequent reconstruction for claudication.
Implications:
- Common and/or external iliac artery ligation can be safely employed for hemorrhage control in renal transplant patients.
- This procedure carries a low risk of limb loss, even without immediate revascularization.
- It offers a viable option for managing surgical bleeding during renal transplantation.
Abstract:
In order to assess the effect of iliac artery ligation on the distal extremity, the ten year experience of the Johns Hopkins renal transplantation program was reviewed. Among 467 transplant procedures in 390 patients there were six cases in which the common and/or external iliac artery had been ligated for control of untoward hemorrhage from an infected arteriotomy site. These six cases were studied in detail with particular attention to ischemic sequelae in the involved leg. There were no immediate or causally-related deaths. No patient lost a leg or required an immediate reconstructive procedure for limb salvage. Four of the six recovered ambulatory status, and only two of these required a later, elective reconstruction for claudication. The combination of these six with eight other similar patients previously reported provides a total of 14 cases of iliac artery ligation in renal transplant patients. No patient suffered actual limb loss, and only three underwent subsequent elective reconstruction for claudication. It is concluded that common and/or external iliac artery ligation without immediate revascularization may be performed for control of hemorrhage with little danger of limb loss in renal transplant patients.