移植技術と研究

Chronic Renal Failure and Aortoiliac Disease: Two Cases with Different Treatments and Outcome, and Literature Update

Abstract

Maroun M Abou-Jaoudé, Osama S Al Beteddini and Alain N Khalaf

Purpose: An association between peripheral arterial disease (PAD) and end-stage renal disease (ESRD) was suggested. We discuss the cases of two kidney transplant patients of different etiologies, and management outcomes.

Case Report: The first case was for a patient with long-standing complicated type 2 diabetes who suffers from advanced atherosclerotic disease involving both femoro-iliac arterial axes. The patient had successful kidney transplantation (KT) to atherosclerotic external iliac artery after endarterectomy, with a smooth early post operative course and a two-year follow up with no significant morbidity. The second case is for a patient who underwent KT, and who had previously undergone an endovascular bifurcated aortic bi-iliac stent (EVBAIS) for an infra-renal abdominal aortic aneurysm.

Conclusions: The decision concerning the presence of extensive atherosclerosis, endovascular stenting and/or endarterectomy, pre-transplantation assessment, and post-operative course will be presented. The literature is also reviewed to assess practices for detecting PAD in kidney transplant patients, and subsequent management options.