Martin-Conejero A, Serrano-Hernando F J, Reina-Gutierrez T, Rial-Horcajo R, Ponce-Cano A I, Blanco-Cañibano E
Department of Vascular Surgery, Hospital Clínico San Carlos, Prof. Martin Lagos, Madrid 28040, Spain.
Transplant Proc. 2003 Dec;35(8):2953-7. doi: 10.1016/j.transproceed.2003.10.081.
Although aortoiliac aneurysm in kidney transplant patients is uncommon, aortic clamping during the surgical repair of an aneurysm could pose a risk to the grafted kidney and might also increase the risk of vascular prosthesis infection due to immunosuppression. Herein, we present our results related to the treatment of the aortoiliac aneurysm subsequent to kidney transplant.
Four male kidney transplant recipients underwent surgery for aortoiliac aneurysm repair.
In the first patient, we protected the kidney graft by perfusion with cold physiological saline. No such protective measures were taken in the remaining three patients other than reducing warm ischemia to a minimum. In one patient with occlusive disease and impaired graft function, renal function improved after surgery. In the other three patients renal function was unaffected by surgery. Despite immunosuppression, no infection of the prostheses was observed.
Surgery for aortoiliac aneurysm can be safely performed in kidney transplant patients. No ischemic damage is incurred by the graft and perioperative infection can be easily avoided. The need to protect the graft during the surgical procedure should be evaluated in each individual case according to predicted times of ischemia and vascular reconstruction and preoperative graft function.
虽然肾移植患者发生主髂动脉瘤并不常见，但在动脉瘤手术修复过程中进行主动脉钳夹可能会对移植肾构成风险，并且由于免疫抑制作用，还可能增加血管假体感染的风险。在此，我们展示了与肾移植后继发主髂动脉瘤的治疗相关的结果。
四名男性肾移植受者接受了主髂动脉瘤修复手术。
在首例患者中，我们通过灌注冷生理盐水保护移植肾。除了将热缺血时间降至最短外，其余三名患者未采取此类保护措施。一名患有闭塞性疾病且移植肾功能受损的患者术后肾功能有所改善。其他三名患者的肾功能未受手术影响。尽管存在免疫抑制，但未观察到假体感染。
肾移植患者可安全地进行主髂动脉瘤手术。移植肾不会遭受缺血性损伤，围手术期感染也易于避免。应根据预计的缺血时间和血管重建情况以及术前移植肾功能，对每例患者在手术过程中保护移植肾的必要性进行评估。
