Pittaluga P, Hassen-Khodja R, Cassuto-Viguier E, Batt M, Declemy S, Bariseel H, Toubol J, Le Bas P
Department of Vascular Surgery, Saint Roch University Hospital, Nice, France.
Ann Vasc Surg. 1998 Nov;12(6):529-36. doi: 10.1007/s100169900196.
The occurrence of aortoiliac lesions with renal transplantation is an increasingly common combination that causes problems regarding operative strategy and indications for aortoiliac reconstruction and renal transplantation. To gain greater insight into these problems we undertook a retrospective multicenter study based on data from 24 kidney transplantation centers in France. A total of 83 patients who underwent both aortoiliac reconstruction and kidney transplantation were enrolled. Patients were divided into two groups according to the order in which the two procedures were performed. Group I included 36 patients in whom aortoiliac reconstruction was performed before kidney transplantation-either during the same procedure (6 patients) or as separate procedures (30 patients). Group II included 47 patients in whom aortoiliac reconstruction was performed after kidney transplantation. The mean age was 49.9 years. There were 43 abdominal aortic aneurysms (51.8%), 36 occlusive aortoiliac lesions (43.4%), and 4 aortoiliac dissections (4.8%). Prosthetic bypass grafting was performed in 72 cases (86.8%), transluminal angioplasty in 6 cases (7.2%), endarterectomy in 3 cases (3.6%), and arterial autograft bypass in 1 case. Renal transplant protection was used during aortoiliac clamping in only 3 patients in group II (7.3%). One month after the second procedure (i.e., kidney transplantation in group I and aortoiliac reconstruction in group II), creatinemia was <200 micromol/L in 27 patients (87.1%) in group I and in 37 patients (88.1%) in group II. The graft survival rate was 86.1% in group I and 89.3% in group II. The overall postoperative morbidity rate was 36.1% (13 cases) in group I and 36.1% (17 cases) in group II. One year after the second procedure creatinemia was <200 micromol/L in 29 patients (93.5%) in group I and 36 patients (93%) in group II. The graft survival rate was 86.1% in group I and 85.1% in group II. The outcome of kidney transplantation is comparable regardless of whether the procedure is performed alone or in association with aortoiliac reconstruction. This finding indicates that kidney transplantation should be performed in patients presenting indications for prior aortoiliac reconstruction. The outcome of aortoiliac reconstruction without graft protection in kidney transplant patients is comparable to the outcome of conventional aortoiliac reconstruction in patients with native kidneys.
肾移植合并主髂动脉病变的情况越来越常见，这给手术策略以及主髂动脉重建和肾移植的指征带来了问题。为了更深入了解这些问题，我们基于法国24个肾移植中心的数据进行了一项回顾性多中心研究。共有83例接受了主髂动脉重建和肾移植的患者纳入研究。根据两项手术的实施顺序将患者分为两组。第一组包括36例患者，他们在肾移植前进行了主髂动脉重建——要么在同一次手术中（6例），要么作为单独的手术（30例）。第二组包括47例在肾移植后进行主髂动脉重建的患者。平均年龄为49.9岁。有43例腹主动脉瘤（51.8%），36例主髂动脉闭塞性病变（43.4%），以及4例主髂动脉夹层（4.8%）。72例（86.8%）进行了人工血管搭桥术，6例（7.2%）进行了腔内血管成形术，3例（3.6%）进行了动脉内膜切除术，1例进行了自体动脉移植搭桥术。在第二组中，仅3例患者（7.3%）在主髂动脉钳夹期间使用了肾移植保护措施。在第二次手术后1个月（即第一组为肾移植，第二组为主髂动脉重建），第一组27例患者（87.1%）和第二组37例患者（88.1%）的血肌酐水平<200微摩尔/升。第一组的移植物存活率为86.1%，第二组为89.3%。第一组的总体术后发病率为36.1%（13例），第二组为36.1%（17例）。在第二次手术后1年，第一组29例患者（93.5%）和第二组36例患者（93%）的血肌酐水平<200微摩尔/升。第一组的移植物存活率为86.1%，第二组为85.1%。无论肾移植是单独进行还是与主髂动脉重建联合进行，其结果都是可比的。这一发现表明，对于有主髂动脉重建指征的患者应进行肾移植。肾移植患者在没有移植物保护的情况下进行主髂动脉重建的结果与天然肾患者进行传统主髂动脉重建的结果相当。
