Ortiz Christopher Chiodo, Miyara Santiago J, Cagliani Joaquin A, Cho Young Min, Guevara Sara, Hayashida Kei, Shinozaki Koichiro, Clement Damian, Becker Lance B, Wang Bo, Krishnasastry K V, Teperman Lewis W, Molmenti Ernesto P
Department of Surgery, Northwell Health, Manhasset, New York.
Department of Emergency Medicine, Northwell Health, Manhasset, New York.
Int J Angiol. 2020 May 16;30(4):310-312. doi: 10.1055/s-0040-1709502. eCollection 2021 Dec.
In this case report we describe a novel and successful revascularization approach in instances of allograft and distal limb ischemia after kidney transplantation. Stenosis proximal to transplant renal artery anastomoses is a complication leading to allograft dysfunction and/or loss. We present a femorofemoral bypass graft with ringed polytetrafluoroethylene (PTFE). In this occasion, revascularization was achieved by a backflow mechanism. The approach described achieved its goal of revascularizing the allograft as well as the distal extremity, with both short- and long-term successful outcomes. Benefits of this approach when compared with re-implantation or procedures directly involving the transplant renal artery include minimization of ischemic time, no need to repair the stenosis, anastomoses with vessels of greater diameter, no need to perfuse the kidney, no need to take down the renal artery anastomosis, no need to dissect the transplanted kidney, and no further lower extremity ischemia. This approach does not require any proximal temporary inflow occlusion (as seen with stent placement) or clamping of the arterial inflow to the kidney. This procedure was completed without having to infuse any preservation fluid into the kidney.
在本病例报告中，我们描述了一种针对肾移植后同种异体移植物和远端肢体缺血情况的新颖且成功的血管重建方法。移植肾动脉吻合口近端的狭窄是导致同种异体移植物功能障碍和/或丧失的一种并发症。我们展示了一种使用带环聚四氟乙烯（PTFE）的股-股旁路移植术。在此情况下，通过逆流机制实现了血管重建。所描述的方法实现了对同种异体移植物以及远端肢体进行血管重建的目标，取得了短期和长期的成功结果。与重新植入或直接涉及移植肾动脉的手术相比，这种方法的优点包括缺血时间最短化、无需修复狭窄、与直径更大的血管进行吻合、无需灌注肾脏、无需拆除肾动脉吻合口、无需解剖移植肾以及不会进一步导致下肢缺血。这种方法不需要任何近端临时血流阻断（如放置支架时所见）或夹闭肾脏的动脉血流。该手术在无需向肾脏输注任何保存液的情况下完成。
