Abdominal aortic aneurysm repair in patients with renal allografts

Aortic reconstruction is being reported in an increasing number of patients after renal transplantation as a result of improved renal graft survival and life expectancy. Aortic surgery in these patients places the pelvic allograft at risk for ischemic damage. We present two separate modalities that have been successfully used in protecting the renal transplant from prolonged warm ischemia during abdominal aortic aneurysm (AAA) repair in two cases. One technique involves an aortofemoral shunt using the perirenal aorta for proximal cannulation and the other technique utilizes an indwelling shunt through the prosthetic graft. Both patients had an uneventful recovery with no evidence of renal dysfunction and their renal function has been stable on long-term follow-up. These cases illustrate two useful alternatives in providing pulsatile perfusion to a transplanted kidney in the iliac fossa during AAA repair. They have been used successfully as simpler alternatives to temporary axillofemoral bypass or extracorporeal pump oxygenation in preventing postoperative renal dysfunction.