Case Report Presentation

March 5, 2010
Mariya Bezugly
AAA
Abdominal Aorta
Abdominal Aortic Aneurysm
 AAA: dilation of the abdominal artery

• Infrarenally
• Pararenally
• Suprarenally
 Who is at risk?
• Male

• 65-85 years old

• People who have ever smoked

• Familial history of heart disease

RISK FACTORS….
Smoking
Diabetes
Hypercholesterolemia
Atherosclerosis
Genetics
Complications
Symptoms

Asymptomatic until….
Diagnosis
• CT scan
• X-ray
• Ultrasound

Diameter
Diagnosis
The prevalence of aneurysms detected through screening
among VA patients age 50-79 is as follows:

AAA Size (cm) Prevalence

3.0-3.9 2.9%

4.0-5.4 1.0%

≥5.5 0.3%

www.ahrq.gov
Introduction Abdominal Aortic Aneurysm Repair in
Patient with a Renal Allograft: A Case Report

• 40 year old male with a right renal

transplant
• Maintained under immunosuppressant's
after surgery
• AAA was discovered upon routine check-up
of the transplant
Diagnosis

Abdominal ultrasound

Serum creatinine

Computed tomography (angiography)

CT Angiographic images
Considerations

• Long-term renal allograft: 18 years 2⁰

systemic atherosclerosis and other occlusive
cardiovascular disease

• 6.4 cm in diameter, infrarenal AAA

• Reported that AAA in renal transplant

patients have aggressive history of high
expansion and rupture rate
Surgical complications

• Ischemic damage due to aortic cross-clamping

during aortic reconstruction
• Clamping: hypertension, myocardial infarction
• Clamp release: hypotension, shock, metabolic
acidosis, myocardial depression
• Renal allograft failure
 Surgery
1. Maintain perfusion to the right kidney by
creating a temporary shunt in the right
common femoral artery to the perirenal aorta

2. Cross-clamp abdominal aorta infrarenally

Temporary Aortofemoral Shunt
CT of post- operative aorta with renal
allograft
 Conclusion
• AAA was discovered in patient with an 18-year old
renal allograft
• The condition of the AAA was dangerous
• Due to the allograft, and the nature of the
procedure, ischemia to the transplant was feared
• Novel technique was performed using a shunt
from the femoral artery to the aorta to maintain
healthy blood supply to the transplanted kidney
Abdominal Aortic Aneurysm Repair in Patient
with a Renal Allograft: A Case Report

The Korean Academy of Medical Science

 References
1. Kim Hyung-Kee, Ryuk Jong-Pil, Choi Hyang Hee, Kwon Sang-Hwy and Huh Seung. Abdominal Aortic Aneurysm Repair in a
Patient with a Renal Allograft: A Case Report. The Korean Academy of Medical Sciences, 2009 24:166-9.
2. Lederle et al. The Aneurysm Detection and Management Study Screening Program. Validation Cohort and Final Results. Arch
Intern Med 2000; 160:1425-1430.

3. Monal N. Ramani, Vimal Rangrajan, Shailesh K. Shah, Indu A. Chadha. Aortic Cross-Clamp Duration and pH Changes. The
Journal of Anaesthetic Clinical Pharmacology, 2006 22(4): 291-295.

4. Reber PU, Vogt B, Steinke TM, Patel AG, Kniemeyer HW. Surgery for aortoiliac aneurysms in kidney transplant recipients. J Cardiovasc
Surg (Torino), 2000; 41: 919–25.

5. Toshiyuki Maeda, Noriyasu Watanabe, and Satoshi Muraki. Abdominal Aortic Aneurysm Repair in a Renal Transplant
Recipient Using a Femoral V-A Bypass. Annals of Thoracic and Cardiovascular Surgery 2009 15: 415–417.

www.vascularweb.org/patients/NorthPoint/Abdominal_Aortic_Aneurysm.html

www.addenbrookes.org.uk/serv/clin/surg/vascular/aortican.html

www.bissy.scot.nhs.uk/master_code/medcon/detail2_body.asp?Recno=23069105&CategoryTitle=16777232

www.utdol.com/patients/content/image.do?imageKey=RHEUM%2F24905