Shrestha B M, McKane W S, Raftery A T
Division of Renal Transplantation, Sheffield Kidney Institute, Northern General Hospital, Sheffield, United Kingdom.
Transplant Proc. 2007 Jun;39(5):1670-2. doi: 10.1016/j.transproceed.2007.03.100.
An increasing number of abdominal aortic aneurysms (AAA) occur in renal failure patients because of strong association between atherosclerosis and chronic kidney disease. Endovascular aneurysm repair (EVAR) has proven to be an effective modality to treat AAA, particularly in patients with renal disease, because of its several advantages over the standard open procedure, including lower morbidity, shorter operative time, and shorter hospital stay. A Medline search showed a single publication on renal transplantation (RT) following EVAR of AAA. In this context, we report our case of successful RT in a patient who had undergone EVAR 2 years prior for a 5.7-cm AAA. No stent-related complications, such as graft occlusion, dislodgement, dissection, or endoleak, were observed in the perioperative period. The transplanted kidney had primary function leading to a stable serum creatinine of 115 micromol/L at 6 months. Although the long-term outcome of RT after endovascular repair of AAA remains unknown, currently available evidence shows favorable outcomes of EVAR in the normal population, in patients with renal diseases, and in RT recipients; hence, RT should not be denied to renal failure patients who have undergone EVAR in the past.
由于动脉粥样硬化与慢性肾脏病之间存在密切关联，越来越多的腹主动脉瘤（AAA）出现在肾衰竭患者中。血管内动脉瘤修复术（EVAR）已被证明是治疗AAA的一种有效方式，尤其是对于患有肾脏疾病的患者，因为它相对于标准开放手术具有多种优势，包括更低的发病率、更短的手术时间和更短的住院时间。一项医学文献检索显示，仅有一篇关于AAA的EVAR术后肾移植（RT）的报道。在此背景下，我们报告了一例成功进行肾移植的病例，该患者两年前因5.7厘米的AAA接受了EVAR手术。围手术期未观察到与支架相关的并发症，如移植物闭塞、移位、夹层或内漏。移植肾具有原发性功能，术后6个月血清肌酐稳定在115微摩尔/升。尽管AAA血管内修复术后肾移植的长期结果尚不清楚，但目前可得的证据表明，EVAR在普通人群、患有肾脏疾病的患者以及肾移植受者中均有良好的结果；因此，不应拒绝既往接受过EVAR手术的肾衰竭患者进行肾移植。
