Consequences of iliac arterial atheroma on renal transplantation
Consequences of iliac arterial atheroma on renal transplantation
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DOI：
10.1016/s0022-5347(05)00325-3
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发表时间：
2006-03-01
影响因子：
6.6
通讯作者：
Benoit, G
中科院分区：
文献类型：
--
作者：
Droupy, S;Eschwège, P;Benoit, G
目的：由于受体年龄在过去15年中显著增加，外科医生有时必须处理髂动脉系统的动脉粥样硬化病变。由于更好的术前筛查和预防肾移植等候名单上的患者动脉硬化，肾移植期间动脉修复的频率现在应该更低，但在某些患者中，EIA粥样硬化可能需要在肾移植期间进行额外的血管外科手术。我们描述了髂动脉粥样硬化的作用和自1985年以来接受肾移植的患者进行动脉修复的技术方面。材料和方法：在1985年至2000年期间进行的1，110例尸体肾移植中，38例患者在肾移植期间需要动脉内膜切除术，69例被认为不需要任何特殊手术。在38例需要动脉内膜切除术的患者中，共进行了12例端端动脉闭塞，观察到6例AS（50%），而26例侧端动脉闭塞仅观察到1例AS（4%）。患者和移植物的生存曲线显示出显着的负相关性的严重程度atherosclerosis.Conclusions：术前评估的EIA是强制性的肾移植前。动脉粥样硬化性EIA的患者如果可以夹闭动脉进行动脉内膜切除术，则可以进行肾移植。根据我们的经验，在EIA上使用供体补片进行侧端吻合可避免动脉内膜切除术后的AS，从而提供更好的结果。然而，尽管有血管修复，动脉粥样硬化病变需要动脉内膜切除术的患者移植物存活率明显较低。
Purpose: Because recipient age has significantly increased in the last 15 years, surgeons must sometimes deal with atherosclerotic lesions of the iliac arterial system. Arterial restoration during renal transplantation should now be less frequent due to better preoperative screening and the prevention of arteriosclerosis in patients on renal transplantation waiting lists but in some patients EIA atheroma may require an additional surgical vascular procedure during renal transplantation. We describe the role of iliac artery atherosclerosis and the technical aspects of arterial restoration performed in patients who have undergone renal transplantation since 1985.Materials and Methods: In a series of 1,110 cadaveric renal transplantations performed between 1985 and 2000, 38 patients required endarterectomy during renal transplantation and 69 were considered not to require any special procedure.Results: In the 38 patients requiring endarterectomy a total of 12 end-to-end arterial anastomoses were performed and 6 ASs (50%) were observed, while 26 side-to-end arterial anastomoses were performed with only 1 AS (4%). Patient and graft survival curves showed a significant negative correlation with the severity of atherosclerosis.Conclusions: Preoperative assessment of the EIA is mandatory before renal transplantation. Renal transplantation can be performed in patients with an atheromatous EIA if the artery can be clamped for endarterectomy. In our experience side-to-end anastomosis using a donor patch onto the EIA provides better results by avoiding AS after endarterectomy. However, despite vascular repair graft survival is significantly lower in patients with atheromatous lesions requiring endarterectomy.