Endovascular Repair of Abdominal Aortic Aneurysm with Coexisting Renal Allograft: Case Report and Literature Review

The coexistence of an abdominal aortic aneurysm (AAA) and a pelvic renal allograft is a unique clinical situation. Because of the increased susceptibility of the transplant kidney to ischemic injury, various approaches have been developed to minimize allograft ischemia during open aneurysm repair. Endovascular techniques have the potential advantage in this situation of greatly diminishing renal ischemia time. To our knowledge, this approach has not been reported in this situation. We report a case of a 61-year-old male with a 7.0-cm AAA and a functioning right pelvic transplant kidney. There was an adequate aneurysm neck below the level of the superior mesenteric artery with occluded renal arteries. Successful endovascular repair of the aneurysm was achieved using a bifurcated graft and bilateral iliac extensions. Perfusion to the renal allograft was maintained throughout the procedure except for short periods when the graft was expanded with a balloon. Short-term follow-up reveals successful aneurysm exclusion and no deterioration in renal function. This exciting new approach to this challenging clinical problem is reviewed along with other methods of minimizing renal allograft ischemia.