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2021 Ultima Pubblicazione

2021 Ultima Pubblicazione

Filippo Ghidini, Federica De Corti, Francesco Fascetti Leon, Diletta Trojan, Mattia Parolin, Costanza Tognon, Marco Castagnetti, Enrico Vidal, Piergiorgio Gamba 22 June 2021

Bench thrombolysis and "autotransplantation" as a rescue treatment for venous thrombosis after living-donor kidney transplantation

Pediatric Transplantation  2021 June 22; https://doi.org/10.1111/petr.14074

Abstract

Introduction: Allograft venous thrombosis is a severe complication after kidney transplantation (KT). Early diagnosis and prompt treatment are crucial in preserving the survival of the allograft. In this study, we aimed to describe an emergent strategy for the management of acute allograft venous thrombosis.

Case Presentation: A 4-year-old girl, weighing 13.5 kg, was diagnosed with bilateral congenital renal hypodysplasia, urogenital sinus and anorectal malformation. The patient was referred to our department for living-donor KT. Her mother was eligible as a donor, presenting a body weight ratio of 1:4.5. Thrombosis of the inferior vena cava (ICV) was also identified, without any predisposing factor for thrombophilia. KT was performed by an extraperitoneal approach without complications. Venous anastomosis required a human vascular graft sutured to the ICV, and renal artery was anastomosed to the aorta. On postoperative day (POD) 8, acute abdominal pain and hematuria led to the diagnosis of an allograft venous thrombosis. An emergent laparotomy was required to explant the allograft, followed by bench surgery. The allograft was irrigated with thrombolytic agents and lactated Ringer's solution and then after removing the venous vascular graft, it was reimplanted through vascular anastomosis with the ICV and aorta. The recovery of perfusion and function was good with diuresis since day 4 after re-surgery. At 2-year follow-up, the child presented normal allograft function with an estimated GFR of 65 ml/min/1.73 m2

Conclusions: According to our experience, explantation of the kidney allograft, followed by irrigation with thrombolytics in bench surgery, and reimplantation resulted in unexpected optimal outcomes in the case of allograft venous thrombosis.

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Comparisons between prosthetic vascular graft and saphenous vein graft in femoro-popliteal bypass.

Comparisons between prosthetic vascular graft and saphenous vein graft in femoro-popliteal bypass.

Park KM, Kim YW, Yang SS, Kim DI. 20 May 2015

Annals of Surgical Treatment and Research (2014)
Infrainguinalfemoropopliteal bypass (IFPB) is recommended to peripheral arterial disease (PAD) with a long occlusion of the superficial femoral artery (SFA). The aims of our study were to determine the patency of graft materials, and identify the risk factors of graft failure

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Cryopreserved saphenous vein graft in infrainguinal bypass.

Cryopreserved saphenous vein graft in infrainguinal bypass.

Hartranft CA, Noland S, Kulwicki A, Holden CR, Hartranft T 06 November 2014

Journal of vascular surgery (2014)
Autogenous saphenous vein is the ideal conduit for lower extremity revascularization. Unfortunately, autogenous vein is unavailable in up to 20% of patients. Synthetic grafts provide an alternative; however, their use in distal revascularization has shown varying results. In addition, infected surgical sites preclude their use. Currently, there are limited outcome data for cryopreserved saphenous vein use in regard to long-term patency and limb salvage rates.

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Saphenous vein graft intervention: status report 2014

Saphenous vein graft intervention: status report 2014

Soverow J, Lee MS. 06 December 2014

 2014 Dec;26(12):659-67.

Given their frequent use as bypass conduits and high rates of degeneration, saphenous vein grafts (SVGs) will continue to require percutaneous coronary intervention. Due to their unique physiology, SVGs pose special challenges to the interventionalist. Preintervention evaluation of hemodynamic significance is hampered by limited data and uncertainty regarding the validity of fractional flow reserve. Intraprocedural complications, particularly distal embolization and no-reflow, are common but may be mitigated by various techniques. Despite advances in the field, SVG intervention is associated with worse outcomes - including increased rates of periprocedural myocardial infarction, restenosis, target vessel revascularization, non-target disease progression, and death - compared with native vessel intervention. This paper reviews the most recent data and techniques available to the interventionalist seeking to improve outcomes after SVG intervention.

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