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    Case Report Presentation: March 5, 2010 Mariya Bezugly

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    Maria Bezugly
    This case report describes the abdominal aortic aneurysm (AAA) repair surgery of a 40-year-old male with an 18-year-old renal transplant. Due to risks of ischemia to the transplanted kidney during aortic clamping, surgeons used a novel technique of creating a temporary shunt from the femoral artery to the perirenal aorta to maintain blood flow to the kidney. A 6.4 cm infrarenal AAA was discovered on CT scan. The surgery involved cross-clamping the abdominal aorta infrarenally after establishing the shunt. This successful procedure addressed the dangerous AAA while preserving the function of the long-term renal allograft.

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    Case Report Presentation: March 5, 2010 Mariya Bezugly

    Uploaded by

    Maria Bezugly
    357 views26 pages
    This case report describes the abdominal aortic aneurysm (AAA) repair surgery of a 40-year-old male with an 18-year-old renal transplant. Due to risks of ischemia to the transplanted kidney during aortic clamping, surgeons used a novel technique of creating a temporary shunt from the femoral artery to the perirenal aorta to maintain blood flow to the kidney. A 6.4 cm infrarenal AAA was discovered on CT scan. The surgery involved cross-clamping the abdominal aorta infrarenally after establishing the shunt. This successful procedure addressed the dangerous AAA while preserving the function of the long-term renal allograft.

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    abdominal ayortic aneurism in a patient post transplant

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    aaa ppt

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    This case report describes the abdominal aortic aneurysm (AAA) repair surgery of a 40-year-old male with an 18-year-old renal transplant. Due to risks of ischemia to the transplanted kidney during aortic clamping, surgeons used a novel technique of creating a temporary shunt from the femoral artery to the perirenal aorta to maintain blood flow to the kidney. A 6.4 cm infrarenal AAA was discovered on CT scan. The surgery involved cross-clamping the abdominal aorta infrarenally after establishing the shunt. This successful procedure addressed the dangerous AAA while preserving the function of the long-term renal allograft.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    357 views26 pages

    Case Report Presentation: March 5, 2010 Mariya Bezugly

    Uploaded by

    Maria Bezugly
    This case report describes the abdominal aortic aneurysm (AAA) repair surgery of a 40-year-old male with an 18-year-old renal transplant. Due to risks of ischemia to the transplanted kidney during aortic clamping, surgeons used a novel technique of creating a temporary shunt from the femoral artery to the perirenal aorta to maintain blood flow to the kidney. A 6.4 cm infrarenal AAA was discovered on CT scan. The surgery involved cross-clamping the abdominal aorta infrarenally after establishing the shunt. This successful procedure addressed the dangerous AAA while preserving the function of the long-term renal allograft.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 26

    Case Report Presentation

    March 5, 2010
    Mariya Bezugly
    AAA
    Abdominal Aorta
    Abdominal Aortic Aneurysm
    AAA: dilation of the abdominal artery

    • Infrarenally
    • Pararenally
    • Suprarenally
    Who is at risk?
    • Male

    • 65-85 years old

    • People who have ever smoked

    • Familial history of heart disease


    RISK FACTORS….
    Smoking
    Diabetes
    Hypercholesterolemia
    Atherosclerosis
    Genetics
    Complications
    Symptoms

    Asymptomatic until….
    Diagnosis
    • CT scan
    • X-ray
    • Ultrasound

    Diameter
    Diagnosis
    The prevalence of aneurysms detected through screening
    among VA patients age 50-79 is as follows:

    AAA Size (cm) Prevalence

    3.0-3.9 2.9%

    4.0-5.4 1.0%

    ≥5.5 0.3%

    www.ahrq.gov
    Introduction Abdominal Aortic Aneurysm Repair in
    Patient with a Renal Allograft: A Case Report

    • 40 year old male with a right renal


    transplant
    • Maintained under immunosuppressant's
    after surgery
    • AAA was discovered upon routine check-up
    of the transplant
    Diagnosis

    Abdominal ultrasound

    Serum creatinine

    Computed tomography (angiography)


    CT Angiographic images
    Considerations

    • Long-term renal allograft: 18 years 2⁰


    systemic atherosclerosis and other occlusive
    cardiovascular disease

    • 6.4 cm in diameter, infrarenal AAA

    • Reported that AAA in renal transplant


    patients have aggressive history of high
    expansion and rupture rate
    Surgical complications

    • Ischemic damage due to aortic cross-clamping


    during aortic reconstruction
    • Clamping: hypertension, myocardial infarction
    • Clamp release: hypotension, shock, metabolic
    acidosis, myocardial depression
    • Renal allograft failure
    Surgery
    1. Maintain perfusion to the right kidney by
    creating a temporary shunt in the right
    common femoral artery to the perirenal aorta

    2. Cross-clamp abdominal aorta infrarenally


    Temporary Aortofemoral Shunt
    CT of post- operative aorta with renal
    allograft
    Conclusion
    • AAA was discovered in patient with an 18-year old
    renal allograft
    • The condition of the AAA was dangerous
    • Due to the allograft, and the nature of the
    procedure, ischemia to the transplant was feared
    • Novel technique was performed using a shunt
    from the femoral artery to the aorta to maintain
    healthy blood supply to the transplanted kidney
    Abdominal Aortic Aneurysm Repair in Patient
    with a Renal Allograft: A Case Report

    The Korean Academy of Medical Science


    References
    1. Kim Hyung-Kee, Ryuk Jong-Pil, Choi Hyang Hee, Kwon Sang-Hwy and Huh Seung. Abdominal Aortic Aneurysm Repair in a
    Patient with a Renal Allograft: A Case Report. The Korean Academy of Medical Sciences, 2009 24:166-9.
    2. Lederle et al. The Aneurysm Detection and Management Study Screening Program. Validation Cohort and Final Results. Arch
    Intern Med 2000; 160:1425-1430.

    3. Monal N. Ramani, Vimal Rangrajan, Shailesh K. Shah, Indu A. Chadha. Aortic Cross-Clamp Duration and pH Changes. The
    Journal of Anaesthetic Clinical Pharmacology, 2006 22(4): 291-295.

    4. Reber PU, Vogt B, Steinke TM, Patel AG, Kniemeyer HW. Surgery for aortoiliac aneurysms in kidney transplant recipients. J Cardiovasc
    Surg (Torino), 2000; 41: 919–25.

    5. Toshiyuki Maeda, Noriyasu Watanabe, and Satoshi Muraki. Abdominal Aortic Aneurysm Repair in a Renal Transplant
    Recipient Using a Femoral V-A Bypass. Annals of Thoracic and Cardiovascular Surgery 2009 15: 415–417.

    www.vascularweb.org/patients/NorthPoint/Abdominal_Aortic_Aneurysm.html

    www.addenbrookes.org.uk/serv/clin/surg/vascular/aortican.html

    www.bissy.scot.nhs.uk/master_code/medcon/detail2_body.asp?Recno=23069105&CategoryTitle=16777232

    www.utdol.com/patients/content/image.do?imageKey=RHEUM%2F24905

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