[Abdominal aortic aneurysms and kidney transplantation]

Area of Science:

• Vascular Surgery
• Nephrology
• Transplantation Surgery

Context:

• Abdominal aortic aneurysm (AAA) repair presents unique challenges in patients with renal transplants, where the renal artery is anastomosed to the iliac artery.
• Managing renal function during AAA treatment is paramount, particularly in this vulnerable patient population.

Purpose:

• To review and discuss various surgical techniques for abdominal aortic aneurysm (AAA) repair in patients with a history of renal transplantation.
• To evaluate methods for preserving renal function during AAA repair, considering different bypass strategies and hypothermia techniques.

Summary:

• A review of 27 cases of AAA in renal transplant recipients highlights diverse surgical approaches.
• Techniques to maintain renal perfusion during aortic clamping include axillo-femoral bypass, Gott aortofemoral shunt, and partial extracorporeal perfusion.
• Hypothermia and strategies to minimize ischemia time, such as maintaining blood flow or fashioning distal anastomoses first, are discussed.
• Simultaneous AAA repair and renal transplantation is contraindicated due to high sepsis risk in immunosuppressed patients.

Impact:

• Provides insights into surgical considerations for abdominal aortic aneurysms in renal transplant recipients.
• Highlights the importance of tailored strategies to protect renal function during complex vascular interventions.
• Informs surgical decision-making regarding the management of renal perfusion and infection risk in this specific patient group.