Preserved Renal Function in Kidney Transplantation over a Thrombosed Aortobifemoral Bypass Graft: The Role of Retrograde Flow and Early Thrombolysis.

Saúl Pampa-Saico,Ana Fernández-Rodríguez,Sara Jiménez-Alvaro,Antonio Chinchilla,Roberto Marcén,Maite Rivera-Gorrín,Fernando Caravaca-Fontán,Juan Sánchez

doi:10.1155/2016/6579591

Saúl Pampa-Saico, Ana Fernández-Rodríguez + Show 6 more

Open Access

https://doi.org/10.1155/2016/6579591

Copy DOI

Abstract

Aortobifemoral bypass (ABFB) thrombosis is not uncommon, and when the artery of a renal graft is implanted on a bypass the risk of graft loss is high. We report the case of a 48-year-old woman with a previous history of ABFB under antiplatelet therapy and a kidney allograft implanted on the vascular prosthesis, who presented with acute limb ischemia and severe renal impairment. Imaging techniques revealed a complete thrombosis of the proximal left arm of the ABFB. However, a faint retrograde flow over the graft was observed thanks to the recanalization of distal left bypass by collateral native arteries. This unusual situation not previously reported in a kidney transplant setting, together with an early diagnosis, allowed graft survival until an early local thrombolysis resolved the problem. Two years later, renal function remains normal.

Highlights

Thrombosis of an aortobifemoral bypass (ABFB) graft is a common complication that may occur in about 10–15% of the cases within the first five years after surgery [1]
We report the case of a 48-year-old woman with a previous history of Aortobifemoral bypass (ABFB) under antiplatelet therapy and a kidney allograft implanted on the vascular prosthesis, who presented with acute limb ischemia and severe renal impairment
When a renal allograft artery is implanted on a vascular prosthesis there is a higher risk of thrombosis and subsequent graft loss [2]

Summary

Introduction

Thrombosis of an aortobifemoral bypass (ABFB) graft is a common complication that may occur in about 10–15% of the cases within the first five years after surgery [1]. When a renal allograft artery is implanted on a vascular prosthesis there is a higher risk of thrombosis and subsequent graft loss [2]. We report the case of a patient presenting a complete occlusion of the arterial bypass in which renal graft perfusion was partially maintained by retrograde flow from collateral arteries in the distal end of the aortobifemoral bypass. Diagnosis and preemptive treatment with local fibrinolysis allowed the resolution of thrombosis and complete recovery of kidney graft function

Case Report

Discussion