Galazka Z, Grochowiecki T, Jakimowicz T, Kowalczewski M, Szmidt J
Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland.
Transplant Proc. 2011 Oct;43(8):2908-10. doi: 10.1016/j.transproceed.2011.08.023.
Atherosclerosis is common in end-stage renal disease patients on dialysis. However, it has previously been considered to be a relative contraindication to kidney transplantation. Currently, patients with extended indications are accepted onto the waiting list, including those with severe atherosclerosis. These patients require vascular procedures before or during kidney transplantation. The aim of this study was to present our experience with vascular reconstruction before kidney transplantation.
Twelve atherosclerotic, uremic patients referred to be candidates for kidney transplantation were refused because of occlusive lesions of the iliac arteries or the distal aorta. The 10 males and 2 females had an age range of 45 to 68 years. Preoperative assessments consisted of a Doppler ultrasound and an angio computed tomography scan. The reconstructions were performed with aorto-biliac, aorto-bifemoral, or ilio-femoral dacron grafts in 7, 4, and 1 patient, respectively, under general anesthesia.
There were no major postoperative complications; the patients were discharged and placed on a special waiting list. Eight patients received kidney allografts, including one living-related transplantation. All procedures were performed with arterial anastomosis of the transplanted kidney to the side of the prosthesis. No patient developed signs of arterial graft infection. In the postoperative period, there were no arterial or transplanted kidney-related complications, except for delayed graft function in four cases. The remaining four patients are still on the waiting list.
In end-stage renal disease patients with severe atherosclerosis in the aortoiliac region, vascular reconstruction allows kidney transplantation.
动脉粥样硬化在接受透析的终末期肾病患者中很常见。然而，它以前被认为是肾移植的相对禁忌证。目前，有扩大适应证的患者被列入等待名单，包括那些患有严重动脉粥样硬化的患者。这些患者在肾移植前或移植期间需要进行血管手术。本研究的目的是介绍我们在肾移植前进行血管重建的经验。
12例因髂动脉或腹主动脉远端闭塞性病变而被拒绝作为肾移植候选者的动脉粥样硬化尿毒症患者。10例男性和2例女性，年龄在45至68岁之间。术前评估包括多普勒超声和血管计算机断层扫描。分别在7例、4例和1例患者中，在全身麻醉下使用主动脉-双髂动脉、主动脉-双股动脉或髂股涤纶移植物进行重建。
术后无重大并发症；患者出院并被列入特殊等待名单。8例患者接受了同种异体肾移植，其中包括1例亲属活体移植。所有手术均将移植肾动脉与假体侧进行吻合。没有患者出现动脉移植物感染的迹象。术后，除4例移植肾功能延迟外，无动脉或移植肾相关并发症。其余4例患者仍在等待名单上。
在腹主动脉髂动脉区域患有严重动脉粥样硬化的终末期肾病患者中，血管重建可实现肾移植。
