Tratamiento endovascular de aneurisma de aorta abdominal en un trasplantado renal. Presentación de un caso y revisión

Summary Aims We report a case of aneurysm of the abdominal aorta (AAA) that was treated by endovascular repair in a transplant patient with terminal nephropathy. Case report A 70-year-old, hypertensive, ex-smoking male, with heart disease and hostile abdomen (five previous laparoto-mies, colostomy, eventration), a 6.5 cm AAA and chronic rejection of a kidney transplant with foreseeable need of dialysis. Following the anatomical evaluation carried out with angiography and computerized tomography (CAT) scanning, a bifurcated Extender stent was implanted in order to exclude the AAA. Proximally, the stent was fixed to the infrarenal aorta, and distally the right hypogastric vascularization and the renal graft implanted in the right iliac fossa were preserved, and the left hypogastric artery was occluded. There were no immediate complications from the implantation of the stent; the AAA was successfully excluded and the patency of the graft was checked and a correct distal perfusion was maintained. During the post-operative period the patient successfully recovered from an acute pulmonary oedema secondary to atrial fibrillation and an intestinal subobstruction, and kidney functioning deteriorated, requiring dialysis. Four months later, the computerized tomographic angiography scan showed the aortic stent to be working perfectly and, still waiting for haemodialysis, kidney functioning remained unchanged. Conclusions 1) In high risk patients who are not candidates for open surgery, endovascular repair of AAA is a therapeutic alternative; 2) Implanting an aortic stent involves less occlusion time for the kidney graft and offers a better prognosis; 3) Our own experience shows that the high degree of expansion of AAA in transplant patients can be treated safely and effectively by endovascular interventions.