Ferrari M, Bonanomi G, Vistoli F, Moretto C, Carmellini M, Mosca F
Division of General and Vascular Surgery, University of Pisa, Via Paradisa, 2, Cisanello, 56124 Pisa, Italy.
Ann Vasc Surg. 2001 Sep;15(5):571-4. doi: 10.1007/s10016-001-0007-x.
Aortoiliac surgery performed in renal transplant recipients carries the risk of inducing a prolonged period of ischemia that can threaten organ survival. Recently, endovascular techniques have been increasingly applied but the rate of complications and recurrences remains significant. We report the case of a kidney heterotopic allotransplant recipient who presented with a history of new-onset arterial hypertension, right lower limb claudication, and allograft dysfunction related to a long, eccentric, and ulcerated plaque causing hemodynamic stenosis of suprarenal iliac artery that was successfully managed with surgical endarterectomy. Despite new advances in less invasive procedures such as transluminal angioplasty and stent implantation, surgical endarterectomy of suprarenal iliac artery may be safely performed in selected heterotopic kidney transplant recipients. It allows for complete removal of the plaque, with better long-term results, and does not preclude subsequent endovascular or surgical procedures; therefore it should be considered a therapeutic option in this clinical setting.
在肾移植受者中进行的主髂动脉手术存在诱发长时间缺血的风险，这可能威胁器官存活。近来，血管内技术的应用日益增多，但并发症和复发率仍然很高。我们报告一例肾异位同种异体移植受者的病例，该患者有新发动脉高血压、右下肢间歇性跛行病史，且同种异体移植功能障碍与一个长的、偏心的、溃疡斑块有关，该斑块导致肾上腺髂动脉血流动力学狭窄，通过外科动脉内膜切除术成功治疗。尽管在诸如腔内血管成形术和支架植入等侵入性较小的手术方面有新进展，但在选定的异位肾移植受者中，肾上腺髂动脉的外科动脉内膜切除术仍可安全进行。它能完全清除斑块，长期效果更好，并且不排除随后的血管内或外科手术；因此，在这种临床情况下应将其视为一种治疗选择。
