Antón-Juanilla Marta, Arruza-Echevarría Antonio
Servicio de Urología. Hospital Universitario Cruces. Barakaldo. Vizcaya. España.
Arch Esp Urol. 2021 Jul;74(6):623-627.
Calcification and atherosclerosis of the iliac arteries is very common in dialysis patients, making sometimes impossible the anastomosis of a kidney graft. The objective of this study is to present our kidney transplantation series using vascular prostheses for iliacartery reconstruction and to assess the results obtained in comparison to other published series.
In a single centre where 1090 kidney transplants were performed between January 2013 and December 2019, patients who required vascular reconstruction were identified for their descriptive analysis.
In 9 patients (0.83%) arterial anastomosis was performed to a Gore-tex prosthesis (8) or using a bovine pericardium patch (1). Only in 1 case, the vascular bypass was prior to transplantation; in the other 8 the surgery was simultaneous. In 2 cases, an urgent transplantectomy was done because of acute rejection and prosthetic thrombosis. 6 patients had immediate graft function. 5 patients requireda new surgical or endovascular procedure to resolve complications. At 35 months of mean follow-up, 7 patients maintained renal graft function.
Kidney transplantation with arterial anastomosis to a vascular prosthesis is very rare. Candidates should be carefully selected because of the high risk ofcomplications. Simultaneous vascular reconstruction is preferred. The functional results are satisfactory.
髂动脉钙化和动脉粥样硬化在透析患者中非常常见，有时会导致肾移植时无法进行吻合。本研究的目的是介绍我们使用血管假体进行髂动脉重建的肾移植系列，并与其他已发表的系列进行比较，评估所取得的结果。
在一个单中心，2013年1月至2019年12月期间共进行了1090例肾移植手术，确定需要血管重建的患者进行描述性分析。
9例患者（0.83%）进行了与戈尔特斯假体（8例）或使用牛心包补片（1例）的动脉吻合。仅1例患者在移植前进行了血管搭桥；其他8例手术为同期进行。2例患者因急性排斥反应和假体血栓形成进行了紧急移植肾切除术。6例患者移植肾立即发挥功能。5例患者需要进行新的外科手术或血管腔内手术以解决并发症。平均随访35个月时，7例患者维持了移植肾功能。
与血管假体进行动脉吻合的肾移植非常罕见。由于并发症风险高，应谨慎选择候选患者。优先选择同期血管重建。功能结果令人满意。
