A 64-year-old man was referred for vascular evaluation before renal transplantation for ischemic nephropathy. In the past he had undergone bilateral renal artery revascularizations using saphenous vein. At the time of transplant evaluation, he was found to have bilateral aneurysms of the saphenous veins used to bypass his renal artery stenoses. He underwent successful endovascular exclusion of the aneurysms with 2 endovascular AneuRx extension cuffs. This case highlights both the versatility of endovascular treatments as well as the importance of a comprehensive vascular examination.
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References
1.
Hassen-Khodja R, Sala F, Declemy S, et al: Renal artery revascularization in combination with infrarenal aortic reconstruction. Ann Vasc Surg14:577-582, 2000.
2.
Taylor SM, Langan EM III, Snyder BA, et al: Concomitant renal revascularization with aortic surgery: Are the risks of combined procedures justified?Am Surg2000;66:768-772.
3.
Paty PS, Darling RC III, Lee D, et al: Is prosthetic renal artery reconstruction a durable procedure? An analysis of 489 bypass grafts. J Vasc Surg34:127-132, 2001.
4.
Ballard JL, Hieb RA, Smith DC, et al: Combined renal artery stenosis and aortic aneurysm: Treatment options. Ann Vasc Surg10:361-364, 1996.
5.
Ilyas M, Bastnagel WR, Roy S III: Late stenosis of an aortorenal bypass graft fashioned from pericardium. Clin Nephrol46:139-140, 1996.
6.
Geroulakos G, Wright JG, Tober JC, et al: Use of the splenic and hepatic artery for renal revascularization in patients with atherosclerotic renal artery disease. Ann Vasc Surg11:85-89, 1997.
7.
Kalliafas S, Albertine JN, Macierewicz J, et al: Incidence and treatment of intraoperative technical problems during endovascular repair of complex abdominal aortic aneurysms. J Vasc Surg31:1185-1192, 2000.
8.
Kulbaski MJ, Kosinski AS, Smith RB III, et al: Concomitant aortic and renal artery reconstruction in patients on an intensive antihypertensive medical regimen: Long-term results. Ann Vasc Surg12:270-277, 1998.
9.
Dieter RS, Yandow D, Patel A: Poster: Aneurysms and pseudoaneurysms of saphenous vein aortocoronary bypass grafts. Education exhibit, Radiological Society of North America 87th annual meeting, Chicago, IL. Nov 25–30, 2001.
10.
Travis JA, Hansen KJ, Miller PR, et al: Aneurysmal degeneration and late rupture of an aortorenal vein graft: Case report, review of the literature, and implications for conduit selection. J Vasc Surg32:612-615, 2000.
Stanley JC, Ernst CB, Fry WJ: Fate of 100 aortorenal vein grafts: Characteristics of late graft expansion, aneurysmal dilatation, and stenosis. Surgery74:931-944, 1973.
13.
Lavigne JP, Keppenne V, Limet R: Late rupture of a saphenous vein aortorenal graft. J Vasc Surg29:722-723, 1999.
14.
May J, White GH, Yu W, et al: Endoluminal repair: A better option for the treatment of complex false aneurysms. Aust NZ J Surg68:29-34, 1998.
15.
Dieter RS: Transluminal endovascular stent-grafting of aortic dissections and aneurysms: A concise review of the major trials. Clin Cardiol24:358-363, 2001.
16.
Pacanowski JP Jr, Stevens SL, Freeman MB, et al: Endotension distribution and the role of thrombus following endovascular abdominal aortic aneurysm (AAA) exclusion. J Endovasc Ther9:639-651, 2002.
17.
Pacanowski JP Jr, Dieter RS, Stevens SL, et al: The Achilles heel of endovascular abdominal aortic aneurysm exclusion. Wis Med J (in press).
18.
Dieter RS, Chu WC, Pacanowski JP Jr, et al: The significance of lower extremity atherosclerotic occlusive disease. Clin Cardiol25:3-10, 2002.
