• Iliac artery traumas and/ or dissection is not an uncommon complication following renal transplantation. • A poorly perfused graft kidney during anastomosis and/ or absent distal arterial pulsation should prompt suspicion of dissection. • Reported management approaches include surgical bypass, synthetic grafting, endarterectomy, and endovascular stenting. • Herein, we report for the first time the use of an autologous graft derived from the ipsilateral internal iliac artery to salvage this serious clinical scenario. 14-year-old boy, with end stage renal disease who received right lumber renal transplant from his mother. Intra-operatively, significant narrowing of the common iliac artery lumen at the site of arterial anastomosis with absent distal pulsation in the ipsilateral external iliac artery and suboptimal graft perfusion. In-situ graft reperfusion with venotomy in the proximally controlled graft vein and discontinuation of the arterial anastomosis after proximal and distal control of the common iliac artery. The arterial defect was assessed to be wide and medially located making the arteriotomy site unusable for effective arterial re-anastomosis. So, reconstruction of the artery with free arterial graft derived from the ipsilateral internal iliac artery was considered prior to re-establishment of the graft arterial anastomosis. Adequate perfusion of the graft was achieved with immediate diuresis as well as maintained normal pulsation of the external iliac artery. The postoperative course was uneventful, and the child discharged at the 10 th post-operative day with serum creatinine 0.6 mg/dl. Magnetic resonance arteriography was carried out prior to discharge and showed patent single artery with no angulation and adequate graft perfusion.
Osman et al. (Fri,) studied this question.
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