CASE 60: Calcified Iliac Vein in the Setting of an Occluded IVC

Recipient with a history of long-standing occlusion of the IVC. Imaging studies showed a patent left external iliac vein with semi-circumferential calcifications along its dorsal area. As seen in this image, the iliac vein was surrounded by fibrotic tissue that increased the complexity of its dissection.

Rather than applying clamps proximally and distally (that would have crushed the venous calcifications, risking embolization and/or thrombosis), it was decided to apply a clamp on the anterior non-calcified area (blue arrow) of the vein. Note the calcified plaque (yellow arrows) visible through the wall of the posterior half of the vein.

The finalized venous anastomosis (green arrows) can be seen after reperfusion of the kidney. The transplant renal vein is shown with a black arrow.