Endovascular repair of abdominal aortic aneurysm with coexisting renal allograft: Case report and literature review

The coexistence of an abdominal aortic aneurysm (AAA) and a pelvic renal al lograft is a unique clinical situation. Because of the increased! susceptib ility of the transplant kidney to ischemic injury, various approaches have been developed to minimize allograft ischemia during open aneurysm repair. Endovascular techniques have the potential advantage in this situation of g reatly diminishing renal ischemia time. To our knowledge, this approach has not been reported in this situation. We report a case of a 61-year-old mal e with a 7.0-cm AAA and a functioning right pelvic transplant kidney. There was an adequate aneurysm neck below the level of the superior mesenteric, artery with occluded renal! arteries. Successful endovascular repair of the aneurysm was achieved using a bifurcated graft and bilateral iliac extensi ons. Perfusion to the renal allograft was maintained throughout the procedu re except for short periods when the graft was expanded with a balloon. Sho rt-term follow-up reveals successful aneurysm exclusion and no deterioratio n in renal function. This exciting new approach to this challenging clinica l problem is reviewed along with other methods, of minimizing renal allogra ft ischemia.