TY  - CHAP
M1  - Book, Section
TI  - Iliac Artery Stenosis: Ilio-Iliac Bypass
A1  - Miyara, Santiago J
A1  - McCann-Molmenti, Alexia
A1  - Guevara, Sara
A1  - Vemuri, Anshul
A1  - Putterman, Daniel M
A1  - Krishnasastry, Kambhampathy
A1  - Molmenti, Ernesto P
A2  - Molmenti, Ernesto Pompeo
Y1  - 2023
N1  - 
T2  - Molmenti’s Kidney and Pancreas Transplantation: Operative Techniques and Medical Management, 2e
AB  - Stenoses  proximal  to  transplant  renal  artery  anastomoses  are  a  complication  that  leads  to  allograft  dysfunction.  In  this  case,  a  45-year-old  male  was  transplanted  a  deceased  donor  kidney  with  2  arteries  implanted  with  an  aortic  patch.  Reperfusion  of  the  organ  was  complicated  by  bleeding  at  the  proximal  site  of  the  anastomosis.  Controlling  the  bleeding  was  very  difficult  given  the  deep  pelvis  and  the  body  habitus  of  the  recipient.  The  iliac  artery  had  to  be  re-clamped  and  several  6-0  polypropylene  stitches  were  placed  at  the  proximal  end  of  the  donor  aortic  patch.  Post-operatively,  the  urine  output  was  low,  and  the  lower  extremity  on  the  side  of  the  transplant  showed  a  markedly  diminished  dorsal  pedal  pulse,  decreased  sensation,  and  pitting  edema  when  compared  to  the  contra  lateral  lower  extremity.  An  arterial  duplex  showed  a  high  grade  stenosis  of  the  external  iliac  just  proximal  to  the  renal  artery  anastomosis,  with  increased  flow  velocity  at  the  transplant  arterial  anastomosis.  Angiography  confirmed  an  iliac  artery  stenosis  (most  likely  at  the  location  where  the  stitches  had  been  placed  to  control  the  post-reperfusion  hemorrhage.  No  stenosis  was  observed  at  the  origin  of  the  renal  arteries.  We  performed  a  common  iliac  to  distal  external  iliac  artery  bypass  with  a  polytetrafluoroethylene  (PTFE)  ringed  graft  (Figures  112-43  and  112-44).  Adequate  flow  was  re-established  to  the  kidney  as  well  as  to  the  lower  extremity  (Figures  112-45–112-50)  with  immediate  resolution  of  all  findings.  This  approach  requires  only  a  brief  proximal  clamping  of  the  arterial  inflow  to  the  kidney.  We  did  not  infuse  any  preservation  fluid  into  the  kidney  during  the  brief  time  of  clamping  for  the  anastomosis.  Our  technique  allows  for  re-vascularization  of  both  the  allograft  and  the  lower  extremity.  Benefits  of  this  approach  when  compared  to  re-transplantation  or  procedures  directly  involving  the  transplant  renal  artery  include:  minimization  of  ischemic  time,  no  need  to  repair  the  stenosis,  anastomoses  with  vessels  of  grater  diameter,  no  need  to  stop  the  blood  flow  to  the  kidney  and  perfuse  it  with  preservation  fluid,  no  need  to  take  down  the  transplant  renal  artery  anastomosis,  no  need  to  dissect  the  transplanted  kidney,  no  further  lower  extremity  ischemia.  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2024/04/16
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1194189336
ER  -