Aortic surgery in renal transplant patients introduces a complex problem. Various means to protect the transplant kidney under these circumstances have been described including ex vivo renal perfusion, in situ renal perfusion with aortoiliac shunt, in situ renal perfusion with a pump oxygenator, and axillofemoral bypass. The authors' experience with a temporary axillofemoral bypass to maintain perfusion of a renal transplant during aortothromboendarterectomy with patch angioplasty is described. They believe that the risks for injury to the transplant kidney are substantially reduced with maintenance of renal perfusion during aortic occlusion.
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