Endovaskuläre Therapie eines infrarenalen Aortenaneurysmas bei heterotopem Nierentransplantat
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Endovaskuläre Therapie eines infrarenalen Aortenaneurysmas bei heterotopem Nierentransplantat. / Tsilimparis, N; Alevizakos, P; Yousefi, S; Hanack, U; Im Spring, B; Blank, B; Rückert, R I.
in: ZBL CHIR, Jahrgang 132, Nr. 3, 06.2007, S. 220-225 .Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung
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TY - JOUR
T1 - Endovaskuläre Therapie eines infrarenalen Aortenaneurysmas bei heterotopem Nierentransplantat
AU - Tsilimparis, N
AU - Alevizakos, P
AU - Yousefi, S
AU - Hanack, U
AU - Im Spring, B
AU - Blank, B
AU - Rückert, R I
PY - 2007/6
Y1 - 2007/6
N2 - INTRODUCTION: The indications for endovascular aortic aneurysm repair (EVAR) are mainly established in hostile abdomen, in patients with significant comorbidities which affect the general operability of the patient and, given the necessary infrastructure, also in ruptured aneurysm. Along to those, we present another possible indication in the presence of a kidney allograft in patients with aortic aneurysm.METHODS: Based on a case report of aorto-biiliac stent-graft repair of an infrarenal aortic aneurysm in a patient with renal allograft, a systematic review of the literature was performed of all similar cases concerning surgical therapy in this constellation.RESULTS: EVAR was performed using an aorto-biiliac system (Zenith) Trifab, COOK) in a 61-year-old male patient 11 years after heterotopic renal allotransplantation in the right iliac fossa. Preoperative renal function was normal. Because the donor renal artery was anastomosed to the recipient's external iliac artery the stent-graft was implanted from the left common femoral artery to minimize temporary allograft ischemia. The intra- and postoperative course was uneventful with a follow-up of presently 12 months. A primary type-II endoleak (retroleak from a lumbar artery) is being treated conservatively so far with embolization being a future option. At present there are 15 cases of EVAR in renal allograft patients that have been reported, all of them being successful.DISCUSSION: All data existing in the literature reported to date as well as our own experience justify the first choice of EVAR in morphologically suitable cases. One major advantage of EVAR in this constellation is the avoidance of aortic cross clamping which poses the graft at risk of ischemia. Long-term results will be most important for definite assessment of EVAR. However, contrast media application during the operation and for CT surveillance should be considered as a major disadvantage.
AB - INTRODUCTION: The indications for endovascular aortic aneurysm repair (EVAR) are mainly established in hostile abdomen, in patients with significant comorbidities which affect the general operability of the patient and, given the necessary infrastructure, also in ruptured aneurysm. Along to those, we present another possible indication in the presence of a kidney allograft in patients with aortic aneurysm.METHODS: Based on a case report of aorto-biiliac stent-graft repair of an infrarenal aortic aneurysm in a patient with renal allograft, a systematic review of the literature was performed of all similar cases concerning surgical therapy in this constellation.RESULTS: EVAR was performed using an aorto-biiliac system (Zenith) Trifab, COOK) in a 61-year-old male patient 11 years after heterotopic renal allotransplantation in the right iliac fossa. Preoperative renal function was normal. Because the donor renal artery was anastomosed to the recipient's external iliac artery the stent-graft was implanted from the left common femoral artery to minimize temporary allograft ischemia. The intra- and postoperative course was uneventful with a follow-up of presently 12 months. A primary type-II endoleak (retroleak from a lumbar artery) is being treated conservatively so far with embolization being a future option. At present there are 15 cases of EVAR in renal allograft patients that have been reported, all of them being successful.DISCUSSION: All data existing in the literature reported to date as well as our own experience justify the first choice of EVAR in morphologically suitable cases. One major advantage of EVAR in this constellation is the avoidance of aortic cross clamping which poses the graft at risk of ischemia. Long-term results will be most important for definite assessment of EVAR. However, contrast media application during the operation and for CT surveillance should be considered as a major disadvantage.
KW - Angioplasty
KW - Aortic Aneurysm, Abdominal/diagnostic imaging
KW - Aortography
KW - Blood Vessel Prosthesis
KW - Comorbidity
KW - Embolization, Therapeutic
KW - Follow-Up Studies
KW - Humans
KW - Iliac Aneurysm/diagnostic imaging
KW - Iliac Artery/diagnostic imaging
KW - Image Processing, Computer-Assisted
KW - Imaging, Three-Dimensional
KW - Incidental Findings
KW - Kidney Transplantation
KW - Male
KW - Middle Aged
KW - Postoperative Complications/diagnostic imaging
KW - Renal Artery/diagnostic imaging
KW - Risk Factors
KW - Stents
KW - Tomography, X-Ray Computed
KW - Transplantation, Heterotopic
U2 - 10.1055/s-2007-981162
DO - 10.1055/s-2007-981162
M3 - SCORING: Review
C2 - 17610193
VL - 132
SP - 220
EP - 225
JO - ZBL CHIR
JF - ZBL CHIR
SN - 0044-409X
IS - 3
ER -