External iliac artery dissection after renal transplant

We report a case of right external iliac artery dissection in a diabetic and hypertensive patient immediately after transplant resulting in cessation of blood supply to the graft and lower limb. The dissected segment was resected and replaced by a synthetic graft there by restoring the blood supply to the lower limb. The renal graft was removed, re-perfused with cold saline and anastomosed to the internal iliac artery and the arterial blood flow was immediately restored. The postoperative course was uneventful and soon after transplantation the graft functioned well. The patient completed 6-month follow-up with a serum creatinine of 1.0 mg%. We suspect that the vascular clamps might have injured the intima of the external iliac artery, so one should be careful while applying clamps in diseased arteries, which may look apparently normal on Doppler. Occlusion of these diseased arteries by a snare technique during anastomosis is safer in such situations.
Source: Indian Journal of Transplantation - Category: Transplant Surgery Source Type: research