Vascular surgeon in transplantation team, is there a room for such specialist?
Maciej Nowacki1,2, Zbigniew Zietek1,2, Maciej Kotowski1, Karol Tejchman1, Adam Nowacki1,2, Jerzy Sieńko1, Jolanta Nawrocka3, Daniel Kotrych2, Ireneusz Wiernicki2, Joanna Stępniewska1, Leszek Domański3, Marek Droździk3, Marek Ostrowski1.
1Department of General Surgery and Transplantation, Pomeranian Medical University in Szczecin, Poland, Szczecin, Poland; 2Department of Vascular Surgery, Pomeranian Medical University in Szczecin, Poland, Szczecin, Poland; 3Department of Nephrology and Transplantology, Pomeranian Medical university in Szczecin, Poland, Szczecin, Poland
Renal transplant is the best solution for treatment patients with chronic renal failure. Five year survival of patients after kidney transplant is 85% comparing to hemodialysis 35%. Peripherial arterial disease is present in 45-50% of recipients. Significant PAD could be contraindication for renal transplant and arteriosclerosis disease can lead loss of transplanted organ during operation, acute limb ischemia, renal artery stenosis, renal HTN. Optimalisation of conditions for transplant is the key for success.Many transplant centers qualify recipient to renal transplant with examining patients with Doppler ultrasound and if doubt performing CTA. Doppler ultrasound has less sensivity and much less specifity comparing to CTA (91 vs 95% and 86 vs 96%).Vascular complications occurs 1,29-4% kidney transplants and are 3-15% of the cases of graft dysfunction. Most common vascular complications are transplanted renal artery stenosis, transplant arterial and venous thrombosis, arteriovenous fistula (AVF) or intra-renal pseudo-aneurysm or extra-renal pseudo-aneursym. Transplanted renal stenosis is the most common and could be situated in suture site due to technical problems, lesion of the proximal renal artery caused by perfusion or organ harvesting, recipient arterial stenosis due to clamp or arteriosclerotic disease. Arterial thrombosis usually resulting graft loss is usually occur due to technical complications during transplantation or harvesting, technical problems during performing anastomosis, torsion or kinking artery. Renal vein thrombosis could be also associated by technical problems during transplantation, perigraft fluid or vein compression.Other vascular complications such as acute limb ischemia caused by thrombus, dissection, septic bleeding from inflamed vessels usually required vascular surgeon assist. We have reviewed 124 kidney transplants done between 2017 to 2021. We observed that taking part of vascular surgeon or cardiac surgeon (during his training for speciality in transplantology) caused significant (15-19 %) less vesicular complications comparing to control group, more significant in group of recipients with higher risk of vascular complications, arteriosclerotic disease. Post transplant complications such as transplant artery stenosis were succesfully treated by endovascular procedures (angioplasty) or open repair as well as arterial or venous trombectomies. Artery dissection, septic bleeding following inflammation and more complicated procedures like reconstruction of vessels with recipients veins usually were assisted with vascular surgeon. Vascular surgeon could be helpfull "tool" during procedures of patients with higher risk of vascular complications, significant arteriosclerotic disease, intra-operative technical complications, thrombotic complications or could be helpfull with diagnostic prior to surgery or vascular complications following transplant as well treatment such PTA as more common procedures in vascular speciality.
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