Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015:10:138-41.
doi: 10.1016/j.ijscr.2015.03.036. Epub 2015 Mar 20.

Kidney transplantation in a patient with absent right common iliac artery and congenital renal abnormalities

Clifton Ming Tay  1 , Edwin Poh Yiew Siew  2 , Tze-Kiat Ng  3 , Anantharanam Vathsala  4 , Ho Yee Tiong  5
Affiliations

Kidney transplantation in a patient with absent right common iliac artery and congenital renal abnormalities

Clifton Ming Tay et al. Int J Surg Case Rep. 2015.

Abstract

Introduction: Congenital atresia of the common and external iliac arteries is a rare vascular anomaly that may be associated with congenital renal or genitourinary malformations. In ESRD patients, its presence may pose potential problems during renal transplantation.

Case presentation: We report a rare case of kidney transplantation in a patient with VACTERL syndrome who was found to have absent right common and external iliac arteries during pre-operative imaging. Vascular supply to the right lower limb is derived from an anomalous branch from the left internal iliac artery which takes on a convoluted course across the pelvis. Kidney transplantation was performed successfully with implantation performed on the left side.

Discussion: Isolated cases of congenital iliac artery atresia have been described in association with urological abnormalities but no clear association has yet been established. However, we feel that it may be useful to perform routine angiographic evaluation for ESRD patients with congenital genitourinary abnormalities being planned for kidney transplantation. While most cases of congenital iliac artery anomalies are symptomatic with claudication, some remain asymptomatic with normal physical examination findings. There is some evidence in literature suggesting the usefulness of routine pre-operative CT in a selective group of patients.

Conclusion: Kidney transplantation in such cases is safe and we recommend routine pre-operative imaging of patients known to have congenital genitourniary abnormalities. The kidney should be implanted heterotopically to the contralateral side of the vascular anomaly and care must be taken to preserve vascular supply to the lower limbs.

Keywords: Absent iliac artery; Congenital vascular anomaly; Crossed fused ectopia; Kidney transplantation; VACTERL.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Coronal section of CT showing the abdominal aorta continuing as the common left iliac artery which bifurcates into the left internal and external iliac arteries. The right common iliac artery is absent.
Fig. 2
Fig. 2
3D reconstruction of CT showing a missing right common iliac artery and the anomalous branch from the left internal iliac artery crossing the pelvis. A branch arising from the right side of the distal abdominal aorta, superior to the bifurcation, gives off a few pelvic branches before continuing along the pelvic side wall to receive the anomalous branch from the left internal iliac artery just proximal to the femoral canal. This then continues distally into the right lower limb as the right common femoral artery.
Fig. 3
Fig. 3
Intra-operative image of the left external and internal iliac arteries, as well as the preserved anomalous vessel branching off the internal iliac artery.
Fig. 4
Fig. 4
MAG 3 scan depicting perfusion to the transplanted kidney in the left iliac fossa.
See this image and copyright information in PMC

References

    1. Harikrishnan S., Krishnamoorthy K.M., Tharakan J.M. Congenital bilateral aplasia of external iliac arteries. Int. J. Cardiol. 2001;80(1):85–86. - PubMed
    1. Llauger J., Sabaté J.M., Guardia E., Escudero J. Congenital absence of the right common iliac artery: CT and angiographic demonstration. Eur. J. Radiol. 1995;21(2):128–130. - PubMed
    1. Tamisier D., Melki J.P., Cormier J.M. Congenital anomalies of the external iliac artery: case report and review of the literature. Ann. Vasc. Surg. 1990;4(5):510–514. - PubMed
    1. Koyama T., Kawada T., Kitanaka Y. Congenital anomaly of the external iliac artery: a case report. J. Vasc. Surg. 2003;37(3):683–685. - PubMed
    1. Greebe J. Congenital anomalies of the iliofemoral artery. J. Cardiovasc. Surg. 1977;18(3):317–323. - PubMed

LinkOut - more resources