[Abdominal aortic aneurysms and kidney transplantation]

Abstract

Protection of the kidney is fundamental during the treatment of abdominal aortic aneurysms (AAA). This applies particularly in patients with a renal transplant, the artery of which has been implanted on an iliac artery. Reviewing 27 AAA in patients with a renal transplant, the authors discuss the various techniques used. The authors disagree with renal function preservation methods. To maintain perfusion during clamping, different types of bypasses have been described: axillo-femoral, the Gott aortofemoral shunt or a partial extracorporeal perfusion (Campbell). With local or total hypothermia, the clamping time can be lengthened and this is used particularly when an end-to-end anastomosis into the internal iliac artery has been carried out. Since the Lacombe 1986 publication, no renal protection has been carried out for the sake of the technical needs of an operation. To reduce relative ischemia time, either the blood flow in the aortic bifurcation is maintained during the aortic clamping and the fashioning of the proximal anastomosis, or the distal anastomoses are fashioned first (Mathey), thus ensuring sufficient flow into the kidney through the collateral anastomoses between the iliacs, or by combining the 2 techniques (Mellière). The risk of infection in these immuno-depressed patients is discussed and it is concluded that the simultaneous repair of an AAA and the performance of a renal transplantation (Cerilli) is not recommended because of the risk of sepsis.