Mellière D, Becquemin J P, Ecollan P, Fitoussi M
University Paris XII, France.
Cardiovasc Surg. 1994 Aug;2(4):522-4.
Abdominal aneurysmectomy in kidney transplant recipients can be successfully performed without adjunctive protective measures if the period of renal ischaemia is short. A technique that attains this goal is described here. An aortic aneurysm (5 cm) was removed 2 years after kidney transplantation to the left external iliac vessel. The right common iliac artery was divided first and anastomosed to the right branch of the bifurcated graft. Aortic anastomosis was then performed; the period of renal ischaemia was only 20 min. Arterial flow was re-established in the right common iliac artery, providing profuse collateral flow to the transplanted kidney through the internal iliac arteries during the time necessary to complete the left common iliac artery anastomosis. This procedure is feasible unless the internal iliac artery is severely stenosed, occluded or terminally anastomosed to the transplanted renal artery. In all other cases, this technique may be the optimal procedure to protect the kidney during elective abdominal aorta aneurysmectomy in renal transplant recipients by reducing the period of ischaemia to that of one anastomosis only.
如果肾脏缺血时间较短，肾移植受者的腹主动脉瘤切除术无需辅助保护措施即可成功进行。本文描述了一种实现这一目标的技术。肾移植至左髂外血管2年后，切除了一个5厘米的主动脉瘤。首先切断右髂总动脉，并与分叉移植物的右分支吻合。然后进行主动脉吻合；肾脏缺血时间仅为20分钟。右髂总动脉恢复血流，在完成左髂总动脉吻合所需的时间内，通过髂内动脉为移植肾提供丰富的侧支血流。除非髂内动脉严重狭窄、闭塞或与移植肾动脉终末吻合，否则该手术是可行的。在所有其他情况下，通过将缺血时间缩短至仅一次吻合的时间，该技术可能是肾移植受者择期腹主动脉瘤切除术中保护肾脏的最佳手术方法。
