Kashyap V S, Quiñones-Baldrich W J
Department of Surgery, UCLA Center for the Health Sciences, Los Angeles, CA 90095, USA.
Ann Vasc Surg. 1999 Mar;13(2):199-203. doi: 10.1007/s100169900242.
Aortic reconstruction is being reported in an increasing number of patients after renal transplantation as a result of improved renal graft survival and life expectancy. Aortic surgery in these patients places the pelvic allograft at risk for ischemic damage. We present two separate modalities that have been successfully used in protecting the renal transplant from prolonged warm ischemia during abdominal aortic aneurysm (AAA) repair in two cases. One technique involves an aortofemoral shunt using the perirenal aorta for proximal cannulation and the other technique utilizes an indwelling shunt through the prosthetic graft. Both patients had an uneventful recovery with no evidence of renal dysfunction and their renal function has been stable on long-term follow-up. These cases illustrate two useful alternatives in providing pulsatile perfusion to a transplanted kidney in the iliac fossa during AAA repair. They have been used successfully as simpler alternatives to temporary axillofemoral bypass or extracorporeal pump oxygenation in preventing postoperative renal dysfunction.
由于肾移植存活率和预期寿命的提高，肾移植术后接受主动脉重建手术的患者数量日益增加。这些患者接受主动脉手术时，盆腔同种异体移植肾有发生缺血性损伤的风险。我们介绍两种不同的方法，它们已成功用于在两例腹主动脉瘤（AAA）修复术中保护肾移植肾免受长时间热缺血的影响。一种技术是使用肾周主动脉进行近端插管的股主动脉分流术，另一种技术是通过人工血管植入分流管。两名患者均顺利康复，无肾功能障碍迹象，长期随访显示其肾功能稳定。这些病例说明了在AAA修复术中为髂窝内移植肾提供搏动性灌注的两种有用的替代方法。它们已成功用作临时腋股旁路或体外泵氧合的更简单替代方法，以预防术后肾功能障碍。
