Naslov
Renal graft protection during ruptured abdominal aortic aneurysm repair in renal transplant recipients

Autori
Crkvenac Gregorek, Andrea ; Papeš, Dino ; Šnajdar, Irena ; Figl, Josip ; Halužan, Damir ; Meštrović, Tomislav ; Lojo, Nermin ; Škorak, Ivan ; Brižić, Ivan ; Fiolić, Zlatko ; Pavić, Predrag

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
Acta chirurgica Croatica, 18 (2021), Suppl 1 / - , 2021, 69-69

Skup
Godišnji kongres Hrvatskog društva za vaskularnu kirurgiju HLZ-a

Mjesto i datum
Opatija, Hrvatska, 28.10.2021. - 30.10.2021

Vrsta sudjelovanja
Poster

Vrsta recenzije
Domaća recenzija

Ključne riječi
aorta ; aneurysm ; infrarenal aortic aneurysm ; kidney transplant ; graft protection

Sažetak
Aim: Reports on open ruptured AAA treatment in renal graft recipients with successful graft preservation are rare. Methods: Case presentation and literature review Results: A 75-year-old male kidney transplant recipient presented in the emergency service for acute onset abdominal pain lasting 4 hours with hypotension. CT angiography showed a ruptured juxtarenal AAA with a contained retroperitoneal hematoma, and no intraperitoneal bleeding. Although the patient was considered for elective endovascular procedure (EVAR) prior to the rupture, EVAR was not possible at the time of the rupture due to technical issues, so immediate open repair was undertaken. Proximal clamp was placed at the suprarenal level, and distal clamps on common illiac arteries. After clamping, a shunt from the suprarenal aorta to the right common iliac artery was placed, and secured with purse-string suture (Figure 1A and 1B). Graft ischemia time was 5 minutes. After shunt placement, classic reconstruction was performed using straight graft. Diuresis was preserved throughout the procedure and blood urea nitrogen and creatinine levels were normal. Postoperative course was uneventful. Six months postoperative the patient is well, and the renal graft function is preserved. Conclusion: We found two reports reporting on five patients, of which four received different modalities of renal graft protection during ruptured AAA repair: axillo-femoral shunt, femoro-femoral extracorporeal circulation, aorto-femoral (Gott) shunt, perfusion cooling. The function of all grafts was preserved, and all patients survived the procedure (including the patient with no protection). Bypass shunting for preservation of renal graft is a logical, simple and fast method for preservation of renal graft perfusion that can be performed even in ruptured AAA cases. Lack of studies that would show clear benefit during elective repair should not be the reason against shunt use for two reasons: 1) the benefit is difficult to show due to small number of transplanted patients undergoing AAA repair, and 2) renal grafts can tolerate longer ischemia during elective repair than in ruptured AAA cases, because during rupture the graft is usually hypoperfused for some time until the repair is undertaken.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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