Successful renal transplantation with ipsilateral femoral arteriovenous grafts

Background The choice of location for revascularization of a renal allograf t is frequently influenced by the presence of previous pelvic surgery or fa iled allografts that remain in situ. The presence of polytetrafluoroethylen e (PTFE) loop grafts in the femoral vessels may potentially result in iliac venous hypertension, thereby compromising the function of a renal allograf t placed nearby. The purpose of this study is to report the hemodynamic cha nges within the iliac veins as a result of PTFE femoral grafts and report t he outcome of renal allografts placed ipsilateral to such grafts. Methods. Three patients with a failed renal allograft in the right iliac fo ssa and functioning left groin PTFE loop grafts underwent left iliac venogr aphy and hemodynamic measurements of the iliac venous system. All three pat ients underwent renal transplantation in the left iliac fossa without ligat ion or alteration of the loop graft. Standard clinical data were collected after transplantation. Results. All three patients demonstrated widely patent external iliac and c ommon iliac veins ipsilateral to the loop graft. Elevated pressures measure d within the venous limb of the loop graft dissipated rapidly within the co mmon femoral and external iliac veins. All three kidneys were well perfused , as documented by posttransplant technetium 99m-diethylenetriaminepentaace tic acid nuclear renography. All three patients have normal renal function past 7 months after transplant, and all three femoral loop grafts are still functioning. Conclusions. PTFE loop grafts to the femoral vessels are not associated wit h local venous hypertension in the ipsilateral external iliac veins. Revasc ularization of a renal allograft may be performed ipsilateral to a femoral loop graft provided other venous diseases, such as strictures, have been ex cluded.