CASE 36: Iliac Artery Dissection at the Time of Transplantation Treated with a Prosthetic Graft

A deceased donor kidney with two arteries on a common aortic patch was implanted onto the recipient right external iliac artery. After reperfusion, the kidney was found to be poorly perfused, with markedly diminished palpable and dopplerable arterial signals in the external iliac artery both proximal and distal with respect to the site of implantation. Both transplant renal arteries had equally poor arterial flow as well. The external iliac artery was found to have a good palpable pulse at its very proximal site upon its origin from the common iliac artery. A working diagnosis of an external iliac artery dissection (most likely as a result of clamping at the time of implantation) was made.

Close up view of the anastomosis of the donor aortic patch (yellow arrow) (encompassing the two renal arteries, green arrows) onto the external iliac artery (white arrows).

After placing tourniquets on the proximal common, distal external, and proximal internal iliac arteries, and applying a clamp on the transplant renal vein (at a site in close proximity to its anastomosis onto the external iliac vein), the anastomosis between the donor aortic patch (yellow arrow) and the recipient external iliac artery was taken down. A dissection of a thickened arterial intima (blue arrow) was identified. The kidney was perfused with cold preservation solution through both renal arteries. The effluent was drained via a venotomy in the donor renal vein.

After placing tourniquets on the proximal common, distal external, and proximal internal iliac arteries, and applying a clamp on the transplant renal vein (at a site in close proximity to its anastomosis onto the external iliac vein), the anastomosis between the donor aortic patch (yellow arrow) and the recipient external iliac artery was taken down. A dissection of a thickened arterial intima (blue arrow) was identified. The kidney was perfused with cold preservation solution through both renal arteries. The effluent was drained via a venotomy in the donor renal vein.

After placing tourniquets on the proximal common, distal external, and proximal internal iliac arteries, and applying a clamp on the transplant renal vein (at a site in close proximity to its anastomosis onto the external iliac vein), the anastomosis between the donor aortic patch (yellow arrow) and the recipient external iliac artery was taken down. A dissection of a thickened arterial intima (blue arrow) was identified. The kidney was perfused with cold preservation solution through both renal arteries. The effluent was drained via a venotomy in the donor renal vein.

The external iliac artery was replaced with a prosthetic polyester ...