Abstract:
BACKGROUND:Solid organ transplantation in elderly patients has become more common in recent years. An increasing number of patients present with renal failure requiring transplantation and comorbid occlusive or aneurysmal aortic pathology. The optimal strategy for the timing and management of the aortic disease and renal transplantation in these patients is unknown. Before the availability of endovascular therapies, our policy was to provide open repair of aortic disease before cadaveric transplantation, or by simultaneous aortic reconstruction with renal allotransplantation if a living donor was available. Since the wide acceptance of endovascular modalities, our strategy has changed to take advantage of endovascular treatment pre-transplant. This study examines the outcome of both approaches. METHODS:We performed a retrospective review of 12 patients between 1996 and 2009 who underwent both renal transplantation and a major abdominal aortic procedure either simultaneously (n = 6), metachronous, with the procedures occurring within the same month (n = 2), or distant, with the aortic procedures occurring between 5 and 24 months before or after transplantation (n = 4). All patients with occlusive disease underwent an aortobifemoral bypass, one before transplant, one subsequent to transplantation, and four simultaneous with a renal allograft. To assess renal transplant status, patients' serum creatinine levels were followed up every 3 months. Of the 12 patients, eight underwent open aortic procedures, whereas four underwent endovascular aortic aneurysm repair. Patients who underwent endovascular aortic aneurysm repair were followed up with ultrasound examinations at 6-month intervals, and with contrast computed tomography scans every other year. RESULTS:Aortic reconstruction was performed successfully in all the 12 patients irrespective of timing strategy. All the patients who underwent endovascular repair had functional renal allografts for the duration of follow-up. Two patients had simultaneous aortobifemoral bypass and pancreas-kidney transplantation without complication. Among the patients with open aortic repairs, there was one 5-year mortality and one patient had failure of two renal allografts. None of the patients had limb loss, and aortic grafts (one limb required a secondary procedure) remained patent. The 5-year patient survival of 90% and kidney survival of 75% appeared similar to results in the general transplant population without aortic disease. Two significant complications related to the open procedures were observed: two renal transplants developed postoperative hematomas requiring evacuation and one aortobifemoral bypass (ABF) developed a femoral wound infection requiring evacuation and sartorius flap closure. The 30-day mortality rate in all patients was zero. The length of stay for patients receiving simultaneous procedures ranged from 5 to 14 days (median, 10.5) and was significantly lower than the 10-52-day (median, 18) combined length of stay in the metachronous and/or distant groups (p = 0.016). CONCLUSION:The coexistence of aortic disease and renal transplantation is an increasingly common clinical scenario. Exclusion from transplantation of patients with major aortoiliac disease is commonplace in many transplant centers as early registry data suggested a poor outcome. Appropriate planning with a vascular surgical team can lead to outcomes, which are comparable with the general transplant population without significant aortic disease.
journal_name
Ann Vasc Surgjournal_title
Annals of vascular surgeryauthors
Gallagher KA,Ravin RA,Schweitzer E,Stern T,Bartlett STdoi
10.1016/j.avsg.2010.12.007subject
Has Abstractpub_date
2011-05-01 00:00:00pages
448-53issue
4eissn
0890-5096issn
1615-5947pii
S0890-5096(11)00033-1journal_volume
25pub_type
杂志文章abstract:BACKGROUND:To evaluate the effectiveness and patient satisfaction with the use of oxybutynin for treating axillary hyperhidrosis in a large series of patients. METHODS:One hundred two patients with axillary hyperhidrosis were treated with oxybutynin. During the first week, patients received 2.5 mg of oxybutynin once a...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2011.06.007
更新日期:2011-11-01 00:00:00
abstract::Internal jugular vein (IJV) thrombosis is a rare vascular event. The most common causes of internal jugular vein thrombosis are prolonged central venous catheterization, infection, malignancy and ovarian hyperstimulation syndrome. We have presented here a case of an 82-year-old male with chronic kidney disease who pre...
journal_title:Annals of vascular surgery
pub_type:
doi:10.1016/j.avsg.2019.08.074
更新日期:2020-01-01 00:00:00
abstract::Although the left flank retroperitoneal incision is a useful approach for many patients undergoing major aortic reconstruction for aneurysmal and occlusive disease, it has been associated with weakening of the flank muscles, resulting in bulges varying from slight asymmetry to huge hernias. The purpose of this study w...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-006-9021-3
更新日期:2006-03-01 00:00:00
abstract:BACKGROUND:Sex-related differences in outcomes have been identified in patients with peripheral artery disease (PAD). We hypothesized that women with PAD would have equivalent inpatient mortality with men after vascular intervention. METHODS:Patients with a primary diagnosis of critical limb ischemia (CLI) or lifestyl...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.01.006
更新日期:2019-07-01 00:00:00
abstract::To evaluate the impact of central venous obstruction on upper extremity hemodialysis access failure, we retrospectively analyzed our recent experience in managing this problem. We reviewed 158 upper extremity hemodialysis access procedures performed in 122 patients during a 1-year period. Fourteen (11.5%) patients had...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02017408
更新日期:1994-11-01 00:00:00
abstract:BACKGROUND:Advanced age (≥ 80 years) has been associated with adverse outcomes after lower extremity bypass for critical limb ischemia (CLI), but endovascular therapy (ET) is reported to have comparable safety across age groups. Here, we assess the safety and effectiveness of advanced age on outcomes after ET for lifes...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2014.07.028
更新日期:2015-01-01 00:00:00
abstract::Existing animal models do not replicate all aspects of abdominal aortic aneurysms (AAAs), including the rupture mechanisms. From histopathological analyses conducted in humans, it has been found that the vasa vasorum of the AAA wall is the starting point of circulatory failure and that bulging and dilatation of the ab...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2019.08.082
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:Ehlers-Danlos syndrome (EDS) is a hereditary connective tissue disorder caused by mutations in genes involved with collagen matrix formation that results in weakened blood vessels. Endovascular therapy on patients with EDS is fraught with concerns of vessel dissection and access site complications. We descri...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2011.05.028
更新日期:2012-01-01 00:00:00
abstract::Hybrid repair involves both open and endovascular interventions. This technique has been increasingly used in treating complex aortic aneurysms as an alternative to conventional open repairs, mainly because of the avoidance of aortic cross-clamping and the associated increased ischemia time to the viscera. We report a...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2018.12.076
更新日期:2019-07-01 00:00:00
abstract::The hemodynamic effects of combined venoarterial injury and stasis were studied in the hindlimbs of 10 dogs. Femoral arterial blood flow and pressure, peripheral venous pressure, and peripheral resistance were measured after the restoration of blood flow following venoarterial injury and a 4-hour period of occlusion f...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02018865
更新日期:1994-03-01 00:00:00
abstract::Tezosentan is a novel dual endothelin receptor antagonist. The purpose of this study was to examine the effect of tezosentan on lung injury induced by abdominal aortic ischemia-reperfusion (IR) in rats. Thirty-two Wistar-albino rats were randomized into four groups (eight per group) as follows: control group (sham lap...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2008.10.003
更新日期:2009-05-01 00:00:00
abstract::We report the use of manufacturer-customized fenestrated iliac stent grafts to treat common iliac artery aneurysms (CIAAs) in patients with challenging iliac anatomy, unsuitable for iliac branched devices (IBDs). A 71-year-old woman presented with bilateral CIAAs measuring 44 mm and 29 mm and a perivisceral abdominal ...
journal_title:Annals of vascular surgery
pub_type:
doi:10.1016/j.avsg.2019.02.044
更新日期:2019-10-01 00:00:00
abstract:BACKGROUND:Thoracoabdominal aortic aneurysm (TAAA) repairs are technically challenging. The advent of endovascular aneurysm repair in combination with visceral/renal artery bypasses has allowed for hybrid endovascular repair of these aneurysms. The purpose of this study was to evaluate whether outcomes were affected by...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2010.06.004
更新日期:2011-01-01 00:00:00
abstract::Between 1982 and 1991 we performed eight operations on seven patients with carotid artery aneurysms. Their mean age was 52.8 years (range: 20-67 years). Five aneurysms were atherosclerotic, one was associated with Marfan's syndrome, and two were pseudoaneurysms, one occurring after Dacron patch angioplasty and the oth...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02015273
更新日期:1991-11-01 00:00:00
abstract::Myxomas are the most common primary cardiac neoplasms. Multimodality imaging is essential for proper diagnosis and treatment. The cardiovascular manifestations depend on myxomas location and size. Intracardiac obstruction, constitutional symptoms, and infected myxomas have been described. Though uncommon, myxomas shou...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1016/j.avsg.2018.04.024
更新日期:2018-11-01 00:00:00
abstract::The etiology of varicose veins remains elusive. We hypothesized that abnormal cell cycle events in the vein wall may contribute to changes in its structural integrity predisposing to varicosity development. Since cell cycle checkpoint controls are linked to the signaling and execution of apoptotic cascades, possibly a...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169910005
更新日期:2000-01-01 00:00:00
abstract::The purpose of this study is to describe the advantages and value of an endovascular suite in the operating room from a vascular surgeon's perspective. All endovascular procedures were performed in a specially equipped operating room by vascular surgeons using digital fluoroscopic imaging equipment. Between January 1,...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s100169900157
更新日期:1998-05-01 00:00:00
abstract::Fifty-eight patients underwent lower limb amputation for arterial disease over a 30-month period. Mean age of the patients was 72 years. Cardiopulmonary and metabolic risk factors were present in the majority of the patients. Postoperative one-year and three-year mortality rates were 24, 40, and 76%, respectively. Con...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/BF02009459
更新日期:1990-05-01 00:00:00
abstract::Most physicians are aware of the important role that platelets play in thrombus formation. The mechanisms that regulate platelet function are now understood at the molecular level. The same biologic processes that control platelet participation in the hemostatic process also allow platelets to interact with the vessel...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,评审
doi:10.1007/BF02001017
更新日期:1993-03-01 00:00:00
abstract::Celiac aortic localization of mycotic pseudoaneurysm is serious. The conventional treatment, resection of infected tissues with in situ revascularization, is associated with a high surgical morbid-mortality rate. We report a case of mycotic pseudoaneurysm of the abdominal aorta involving visceral arteries excluded by ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2010.01.010
更新日期:2010-08-01 00:00:00
abstract::Information about the variations of the origins of subclavian and vertebral arteries and their course is of great importance for head and neck surgery. The normal vertebral arteries arise as the first branches of the corresponding subclavian arteries. In a minority of cases, the left vertebral artery could arise direc...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2008.02.015
更新日期:2009-01-01 00:00:00
abstract::This report details the case of a patient presenting with a periampullary cancer and an abdominal aortic aneurysm who underwent endovascular repair of the aneurysm prior to pancreaticoduodenectomy. Use of the endovascular approach avoided the need for two major operative interventions. ...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1007/s10016-005-9406-8
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:The research aims to study the effect of circumferential compliance of synthetic vascular prostheses on their healing during implantation in the infrarenal abdominal aorta of pigs. METHODS:In an experiment, 12 pigs were implanted with blood vessel prostheses in the infrarenal abdominal aorta. The prostheses...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.08.117
更新日期:2021-01-01 00:00:00
abstract::The decision-making involved in managing type 2 aortic dissections remains challenging despite the advances in endovascular technology. We report a challenging case of a patient presenting with a type 2 aortic dissection and false lumen extension into an infrarenal abdominal aortic aneurysm (AAA). Severe back pain and...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2012.10.035
更新日期:2013-11-01 00:00:00
abstract::The close proximity of the arch vessels to the origin of many thoracic aortic aneurysms (TAA) may result in placement of the stent struts across the left subclavian or carotid ostia. The purpose of this study is to determine the incidence and impact of transaortic arch vessel fixation during thoracic aortic stent graf...
journal_title:Annals of vascular surgery
pub_type: 临床试验,杂志文章
doi:10.1007/s10016-001-0125-5
更新日期:2002-01-01 00:00:00
abstract::Retracted: "Eversion carotid endarterectomy is associated with impaired postoperative hemodynamic stability compared with the conventional technique" Ann Vasc Surg 2012;26:755e65. This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This a...
journal_title:Annals of vascular surgery
pub_type: 撤回出版物
doi:10.1016/j.avsg.2012.11.002
更新日期:2013-01-01 00:00:00
abstract::Septic thrombophlebitis is a rare diagnosis in this era of widespread antibiotic usage. The clinical diagnosis requires astute clinical suspicion and evaluation. We describe an asplenic 63-year-old woman who presented to the emergency department with a 24-hour history of a tender, swollen, right neck and upper chest w...
journal_title:Annals of vascular surgery
pub_type:
doi:10.1016/j.avsg.2019.03.011
更新日期:2019-10-01 00:00:00
abstract:BACKGROUND:Endovascular repair is associated with better 30-day outcomes than open surgical repair for patients with infrarenal aortic aneurysms. In patients with complex aortic aneurysms (CAAs) requiring suprarenal or supravisceral aortic cross-clamping during open repair, few data exist directly comparing the real-wo...
journal_title:Annals of vascular surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.avsg.2012.05.022
更新日期:2013-04-01 00:00:00
abstract:BACKGROUND:Almost 80% of patients with end-stage renal disease (ESRD) initiate dialysis via a central venous catheter (CVC). CVCs are associated with multiple complications and a high cost of care. The purpose of our project is to determine the impact of early cannulation arteriovenous grafts (ECAVGs) on quality of car...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2019.02.007
更新日期:2019-08-01 00:00:00
abstract:BACKGROUND:Lymphatic interventions have recently been increasingly used for treating lymphatic leak of the abdomen and pelvis. This retrospective case study series and systematic review evaluated the efficacy and safety of lymphatic interventions for the treatment of postoperative lymphatic leak of the abdomen and pelv...
journal_title:Annals of vascular surgery
pub_type: 杂志文章
doi:10.1016/j.avsg.2020.04.063
更新日期:2020-10-01 00:00:00