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Endovascular Preparation With Innovative Custom-Made Stent-Graft Before Kidney Transplantation: The Solution for
Matthieu Arsicot1,2, Raffaele Pio Ammollo1, Marine Bordet1,3
1Service de Chirurgie Vasculaire et Endovasculaire, Hospices Civils de Lyon, Lyon, France.
Insights
A novel EndoPreKiT device facilitates minimally invasive arterial access for kidney transplantation in elderly patients with severe arterial calcification. This breakthrough expands transplant eligibility to more fragile individuals, improving outcomes.
Area of Science:
- Vascular Surgery
- Transplant Surgery
- Medical Devices
Background:
- Increasing age in end-stage renal disease patients presents challenges for arterial access during transplantation.
- Severe iliac artery calcification often contraindicates transplantation in high-risk patients.
- Technical difficulties in clamping and suturing calcified arteries limit surgical options.
Purpose of the Study:
- To introduce and evaluate the EndoPreKiT (Endovascular Preparation for Kidney Transplantation) device.
- To assess the feasibility and safety of a minimally invasive endovascular approach for arterial preparation in kidney transplantation.
- To determine if EndoPreKiT can overcome challenges posed by hostile arterial anatomy in transplant candidates.
Main Methods:
- Development of the EndoPreKiT device: a Dacron graft supported by nitinol rings for arterial anchorage and clamping.
- A stentless section allows direct anastomosis after calcified artery wall removal.
- Initial validation through a cadaveric study followed by implantation in 10 patients with severe arterial calcification.
Main Results:
- Successful implantation of the EndoPreKiT device in all 10 patients.
- Two patients underwent successful kidney transplantation with excellent outcomes at 13 and 3 months post-procedure.
- The device enabled safe arterial clamping and facilitated anastomosis in challenging anatomies.
Conclusions:
- The EndoPreKiT device offers a significant advancement in transplant surgery.
- This minimally invasive approach expands eligibility for kidney transplantation to fragile patients with severe arterial calcification.
- EndoPreKiT potentially broadens the pool of candidates who can benefit from life-saving transplantation.
Abstract:
The increasing age of patients with end-stage renal disease raises the issue of hostile arterial access for transplantation, with technical difficulties associated with clamping and suturing the iliac artery. Some of these patients - who theoretically represent those who would benefit the most from transplantation in terms of mortality - are contraindicated because of anatomical and medical issues. In this context, a specific endovascular device called EndoPreKiT (Endovascular Preparation for Kidney Transplantation) has been designed, enabling arterial access for transplantation via a mini-invasive procedure. It consists of a woven Dacron supported by self-expanding nitinol rings, ensuring anchorage and allowing arterial clamping. The middle part of the anterior face of the device is stentless, enabling the anastomosis directly onto the Dacron once the calcified artery wall has been removed. After a cadaveric study validating its technical feasibility, such device was successfully implanted in 10 patients considered unfit for transplantation due to severe wall calcification. Two of them have been successfully transplanted with excellent outcomes after 13 and 3 months of follow-up. EndoPreKiT device may be a significant breakthrough in transplant surgery, that could expand the horizon of eligibility to include even the most fragile patients with challenging arterial access.
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