Alvarez Castelo L M, García Freire C, Rodríguez-Rivera García J, Chantada Abal V, García Buitrón J, González Martín M
Servicio de Urología, Hospital Juan Canalejo, La Coruña, España.
Arch Esp Urol. 1997 Apr;50(3):275-82.
Three cases of kidney transplantation that required a vascular prosthesis are described and the literature reviewed.
Of 920 cases of kidney transplantation, 3 required a vascular prosthesis to repair the aortoiliac vessels. One patient with severe atherosclerotic disease had an aorto-bifemoral prosthesis (Gore-Tex) six months before renal transplantation and the other two patients required a vascular prosthesis to repair iliac artery lesions discovered during transplantation.
The initial surgical results were satisfactory. No complications arising from the vascular prosthesis were observed. Two patients have a functioning renal graft, but the third patient developed acute tubular necrosis and tubulo-interstitial rejection and died from acute pulmonary edema.
The importance of the preoperative cardiovascular evaluation in patients undergoing kidney transplantation is underscored. Some patients may require a vascular prosthesis. We should therefore be familiar with the prosthetic materials and the surgical techniques, which are not particularly difficult, and optimum results can be achieved. In patients with both end-stage renal disease and severe aortoiliac atherosclerotic disease, the controversy remains whether aortoiliac repair and kidney transplantation should be done simultaneously or in two stages.
描述3例需要血管假体的肾移植病例，并对相关文献进行综述。
在920例肾移植病例中，3例需要血管假体来修复主动脉髂血管。1例患有严重动脉粥样硬化疾病的患者在肾移植前6个月植入了主动脉-双股动脉假体（戈尔泰克斯），另外2例患者需要血管假体来修复移植过程中发现的髂动脉病变。
最初的手术结果令人满意。未观察到血管假体引发的并发症。2例患者的肾移植功能良好，但第3例患者发生了急性肾小管坏死和肾小管间质排斥反应，死于急性肺水肿。
强调了肾移植患者术前心血管评估的重要性。一些患者可能需要血管假体。因此，我们应该熟悉假体材料和手术技术，这些技术并非特别困难，并且可以取得最佳效果。对于终末期肾病合并严重主动脉髂动脉粥样硬化疾病的患者，主动脉髂动脉修复和肾移植应同期进行还是分两期进行仍存在争议。
