Department of Surgery, Surgery and Abdominal Transplantation Division, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium.
World J Surg. 2013 Jul;37(7):1727-34. doi: 10.1007/s00268-013-2028-3.
Arterial anastomosis in transplant patients with severe aortic and iliac atheromatosis is technically challenging and may jeopardize the success of the transplantation procedure. The aim of this retrospective study was to report short- and long-term results of a consecutive series of kidney transplant patients in whom the renal artery was implanted on a prosthetic vascular graft.
Medical charts and outpatient clinical records of patients who had undergone renal artery implantation on a prosthetic graft were reviewed. Data on patient characteristics, indications for transplantation, prior vascular procedures, surgical technique, and postoperative and long-term outcome were collected.
The renal artery was implanted on a prosthetic graft in the course of 27 kidney transplantation procedures. Patients were divided into three groups according to the timing of the vascular intervention in relation to the transplantation. In group A (n = 22), the vascular prosthesis was implanted before kidney transplantation, in group B (n = 2), prosthetic iliac artery replacement and kidney transplantation were performed simultaneously, while in group C (n = 3), the vascular prosthesis was implanted after kidney transplantation. After a median follow-up of 50.5 months, one case of early arterial thrombosis was observed (3.7 %). Infectious complications occurred in two patients (7.4 %) related to mycotic pseudoaneurysms. One hematoma and one evisceration were also encountered, but no late arterial thrombosis nor stenosis were noted. Mean creatinine levels at 1 and 5 years of follow-up were 1.32 ± 0.36 and 1.27 ± 0.56 mg/dl, respectively. Five-year patient and graft survival rates were 85.2 and 74 %, respectively.
Grafting of the renal artery to a vascular prosthesis is feasible and yields good results, despite the technical difficulties involved. We stress the importance of good teamwork.
在严重主动脉和髂动脉粥样硬化的移植患者中进行动脉吻合具有技术挑战性，可能危及移植手术的成功。本回顾性研究的目的是报告连续系列接受肾动脉移植到人造血管移植物的肾移植患者的短期和长期结果。
回顾性分析接受人造血管移植物肾动脉移植的患者的病历和门诊临床记录。收集患者特征、移植适应证、既往血管手术、手术技术以及术后和长期结果的数据。
在 27 例肾移植手术中，肾动脉被移植到人造移植物上。根据血管介入与移植的时间关系，患者分为三组。在 A 组（n = 22）中，在肾移植前植入血管假体；在 B 组（n = 2）中，同时进行人造髂动脉置换和肾移植；在 C 组（n = 3）中，在肾移植后植入血管假体。在中位随访 50.5 个月后，观察到 1 例早期动脉血栓形成（3.7%）。2 例患者（7.4%）发生与真菌性假性动脉瘤相关的感染性并发症。还遇到 1 例血肿和 1 例内脏脱出，但未发现晚期动脉血栓形成或狭窄。1 年和 5 年时的平均肌酐水平分别为 1.32 ± 0.36 和 1.27 ± 0.56mg/dl。5 年时患者和移植物的存活率分别为 85.2%和 74%。
尽管存在技术困难，但将肾动脉移植到血管假体上是可行的，并且效果良好。我们强调良好的团队合作的重要性。
