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[Abdominal aortic aneurysms and kidney transplantation]
O Nussaume1, P Gouny, P Bertrand
1Service de Chirurgie Vasculaire, Fédération AP-HP de Pathologie Vasculaire, Hôpital Tenon, Paris.
Abstract:
Protection of the kidney is fundamental during the treatment of abdominal aortic aneurysms (AAA). This applies particularly in patients with a renal transplant, the artery of which has been implanted on an iliac artery. Reviewing 27 AAA in patients with a renal transplant, the authors discuss the various techniques used. The authors disagree with renal function preservation methods. To maintain perfusion during clamping, different types of bypasses have been described: axillo-femoral, the Gott aortofemoral shunt or a partial extracorporeal perfusion (Campbell). With local or total hypothermia, the clamping time can be lengthened and this is used particularly when an end-to-end anastomosis into the internal iliac artery has been carried out. Since the Lacombe 1986 publication, no renal protection has been carried out for the sake of the technical needs of an operation. To reduce relative ischemia time, either the blood flow in the aortic bifurcation is maintained during the aortic clamping and the fashioning of the proximal anastomosis, or the distal anastomoses are fashioned first (Mathey), thus ensuring sufficient flow into the kidney through the collateral anastomoses between the iliacs, or by combining the 2 techniques (Mellière). The risk of infection in these immuno-depressed patients is discussed and it is concluded that the simultaneous repair of an AAA and the performance of a renal transplantation (Cerilli) is not recommended because of the risk of sepsis.
Insights
Protecting kidney function is crucial when treating abdominal aortic aneurysms (AAA), especially in renal transplant patients. Techniques to maintain kidney perfusion during AAA repair are reviewed, with varied opinions on optimal methods.
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.