Endovascular abdominal aortic aneurysm repair in patients with renal transplant
The first patient was a 60-year-old man presenting with an asymptomatic, 6.0 cm expanding infrarenal AAA (). He underwent a renal transplantation 21 years prior to his current presentation due to renal failure secondary to diabetes and hypertension. The renal artery of the transplanted kidney arose from the right internal iliac artery. His renal function was marginal due to chronic rejection with creatinine and blood urea nitrogen (BUN) values of around 4.0 mg/dL and 50 mg/dL, respectively. His AAA was repaired with a Zenith (Cook Medical Inc., Bloomington, IN, USA) bifurcated stent graft. A 30 mm × 117 mm Zenith main body device was placed through the left common femoral artery with "preclose technique" using 7F Proglide (Abbott Vascular, Redwood City, CA, USA). An 18 mm × 71 mm limb extender was used as the ipsilateral extension. A 24 mm × 71 mm was used as contralateral extension. A type Ib endoleak arising from the right iliac artery was noted on the completion angiogram (). Another 24 mm × 54 mm limb extender was placed to overcome this type Ib endoleak. There was no endoleak with final angiogram (). There was no change in renal perfusion after EVAR according to the completion angiogram. A total of 30 mL of Visipaque (iodixanol) was used for this patient. The total fluoroscopic time was 90 minutes. The patient's renal function was slightly decreased after EVAR (creatinine and BUN of 4.1-4.4 mg/dL and 53-58 mg/dL, respectively). The hemodialysis was not needed after EVAR. The aggravation of chronic rejection led to hemodialysis 4 months after EVAR. Over the following 12 months, no types of endoleak were detected as evaluated by serial colorized duplex scan.