A Salvage Approach for Iatrogenic Iliac Vein Injury During Kidney Transplantation

Background and objectives: Iatrogenic injury to the external iliac vein is a rare surgical complication during kidney transplantation. It can compromise the use of the vein for anastomosis and adversely affect venous return from the ipsilateral lower extremity. Case presentation: We present an innovative salvage technique for addressing iatrogenic injuries to the external iliac vein occurring during its dissection from the surrounding tissues. This approach involves the attachment of an allograft renal vein to the distal segment of the divided external iliac vein using end-to-end anastomosis, while the proximal segment is anastomosed to the allograft renal vein using an end-to-side technique. Early postoperative ultrasound evaluations indicated sufficient venous return from both the transplanted kidney and the lower extremity. A recent follow-up, 12 years post-transplantation, confirmed sustained vascularization and venous return from the allograft. Conclusions: The described technique provides an effective solution for managing significant external iliac vein injuries during kidney transplant procedures. It facilitates the salvage of the vein for anastomosis with the allograft in the ipsilateral iliac fossa without the need for vascular tissue replacement or altering the anastomosis site.