Open repair of infrarenal abdominal aortic aneurysm in a renal transplant recipient using extra-anatomic bypass: a case report

Introduction and Importance: Abdominal aortic aneurysm (AAA) is a common vascular pathology in elderly males and carries a substantial risk of rupture when large or symptomatic. The management of AAA in renal transplant recipients is particularly challenging due to the vulnerability of the transplanted kidney to ischemic injury during aortic cross-clamping and the frequent presence of multiple comorbidities. Presentation of Case: We report the case of a 67-year-old male who presented with chronic low back pain radiating to the hips for 3 months, accompanied by weight loss and intermittent constipation. His medical history was significant for hypertension, chronic kidney disease, a previous cerebrovascular accident, coronary artery disease treated with stent placement, and a left renal transplant performed 6 years earlier. Laboratory investigations were largely unremarkable, except for elevated creatinine and prolonged prothrombin time. Contrast-enhanced magnetic resonance imaging revealed a large 7-cm infrarenal abdominal aortic aneurysm, with the transplanted kidney supplied by the left external iliac artery. Given the aneurysm size, symptoms, and anatomical considerations, surgical intervention was indicated. Clinical Discussion: AAA repair in renal transplant recipients requires meticulous preoperative planning to prevent allograft ischemia and postoperative renal dysfunction. Although endovascular aneurysm repair may be considered in selected cases, anatomical constraints and concerns regarding contrast exposure may limit its applicability. Conclusion: This case demonstrates that open AAA repair with extra-anatomic bypass can be successfully performed in renal transplant recipients, providing effective aneurysm treatment while preserving allograft function. A multidisciplinary, individualized approach remains essential for optimizing outcomes in this high-risk population.