• Vascular Annual Meeting
• Call for Abstracts
• General Information
• Exhibitor Information
• Alumni Association Information
• 2009 Meeting Information
• Future Meeting Dates
• Contact Us

Home > Vascular Annual Meeting > PVSS24. Outcomes of Aortic Surgery in Renal...

PVSS24. Outcomes of Aortic Surgery in Renal Transplant Patients

Katherine A Gallagher, MD; Eugene Schweitzer, MD; David Neschis, MD; Tina Stern, BSN; Stephen T Bartlett, MD
University of Maryland, Baltimore, MD

OBJECTIVES: Transplantation of elderly patients has become increasingly common. Many patients present with concomitant occlusive or aneurysmal aortoiliac disease. The optimal strategy for the timing and management of concomitant aortoiliac disease is unknown. Prior to the availability of endovascular therapies, our policy was to provide open repair of occlusive or aneurysmal disease prior to cadaveric transplantation or if a living donor was available by simultaneous aortoiliac reconstruction with renal allo-transplantation. Since the advent of endovascular methods, our strategy changed to take advantage of endovascular treatment pre-transplant. This study examines the outcome of both approaches.

METHODS: We performed a retrospective review of 12 patients between 1996 and 2009 who underwent both a renal transplantation and a major abdominal aortic procedure (indication aneurysm, 5; occlusive disease, 7) either simultaneously (n=5), within the month prior (n=2) or subsequent to renal transplantation (n=5). All patients with occlusive disease had aortobifemoral bypass, two prior to transplant and five simultaneous with transplantation. In order to assess renal transplant status, patients’ creatinine levels were followed every 3 months. Of the 12 patients, 8 had open aortic procedures, while 4 patients underwent endovascular aortic aneurysm repair (EVAR). Patients who underwent endovascular aortic aneurysm repair were followed with CT scans at 6 month intervals.

RESULTS: Aortic reconstruction done simultaneously, metachronously or distant subsequent to renal transplantation was successfully employed in all twelve patients. All of the patients who underwent EVAR have functional renal allografts. Among the patients with open aortic repairs, three are deceased and one patient has had failure of two renal allografts. No patients had limb loss and aortic grafts (one limb required a secondary procedure) remained patent. Five year patient (90%) and kidney survival (75%) are equivalent to results in the general population without aortic disease. Two patients had aortobifemoral bypass and pancreas-kidney transplantation without complication. There were no major complications related to these procedures, however 2 renal transplants developed hematomas post-operatively requiring evacuation and 1 ABF developed a femoral wound infection requiring evacuation and sartorius flap closure. The 30-day mortality rate in all patients was zero. The length of stay for patients receiving simultaneous procedures ranged from 5 to 17 days.

CONCLUSIONS: The coexistence of aortic disease and renal transplantation is becoming an increasingly common clinical scenario. Exclusion from transplantation of patients with major aortoiliac disease is commonplace in many transplant centers as registry data suggests a poor outcome. Appropriate planning with a vascular surgical team can lead to outcomes which are comparable to the general transplant population without significant aortoiliac occlusive disease.

AUTHOR DISCLOSURES: K.A Gallagher, None; E. Schweitzer, None; D. Neschis, None; T. Stern, None; S.T. Bartlett, None.

Figure 1.