Reparación endovascular de aneurisma aortoilíaco en paciente con trasplante renal

Abstract

Summary Introduction. Conventional surgical correction of aortoiliac aneurysmal pathologies in patients who have undergone a pelvic renal transplant implies a high risk of renal ischemia during aortic clamping. Endovascular repair minimises such a risk and does not require additional manoeuvres in order to preserve renal flow. Case report. A 67-year-old male, exsmoker, with hypertension, dyslipidemic, hyperuricemic, with cardiac insufficiency, ischemic heart disease, triple coronary artery bypass, a kidney transplant (allograft in the left iliac fossa), bilateral mesh inguinal and umbilical herniorrhaphy that presented a 4.5 cm long infrarenal aortic aneurysm (AAA) and a 3.7 cm long aneurysm in the right iliac artery (AAID), both of which were asymptomatic. Given the need to operate on the AAID, together with the coexistence of the AAA and the kidney transplant, it was decided that endovascular repair should be carried out. Under general anaesthetic and systemic heparinisation, an aortoiliac bifurcated Talent ®stent was inserted, the right hypogastric artery was occluded and the patency of the left artery and the anastomosis of the renal transplant were maintained. In the immediate post-operative period no deterioration in kidney functioning was observed. The patient was discharged from hospital five days after the intervention with double antiplatelet treatment (clopidogrel 75 mg and ASA 125 mg). After 8 months of clinical, analytical and radiological (computerised tomography and simple X-rays) follow up, the renal graft remained patent with normal kidney functioning. Conclusions. The main benefit to be derived from aneurysmal endovascular repair in pelvic renal transplants lies in the absence of clamping and the speed and ease with which it can be performed, as compared with the manoeuvres aimed at preserving renal flow used in conventional surgery. For this reason, in the case of suitable anatomies, endovascular repair must be taken into account as one of the preferred treatments. [ANGIOLOGIA 2004; 56: 579-86]