Aortoiliac disease requiring open and endovascular intervention in patients awaiting renal transplant

Mastracci TM, Pasternak J and Szalay D
Division of Vascular Surgery and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

Background: Many patients with chronic renal failure have associated peripheral vascular disease (PVD).  Aortoiliac disease proximal to the recipient site may compromise the success of the transplantation.  Vascular surveillance is an accepted component of post transplant care.  We have extended these principles to include a proactive approach to the identification and treatment of aortoiliac disease in the pre-transplant population.

Methods: Descriptive analysis of a prospective collected database of renal transplant patients at a tertiary care centre in Canada.  We have identified a subgroup of patients who required treatment of aortoiliac disease proximal to the proposed site of transplant.

Results: At our centre, 75 patients underwent renal transplant in the last 12 months.  This population is 62.5% male, with an average age of 52 years (standard deviation [SD] 13.4).  Over the same period, 7 patients required intervention for vascular disease prior to transplantaion.  All patients with clinically significant lesions were male, and the average age was 59 years (SD 2.7).  The underlying cause of renal failure was polycystic kidney in 3, diabetes in 1 and hypertensive nephropathy in 3 patients.  There were 5 operative interventions: 4 aortobi-iliac repairs, and one iliac endarterectomy with angioplasty.  The remaining 2 interventions were percutaneous iliac angioplasty and stents.  The indication for intervention was occlusive disease in 4 and aneurysmal disease in 3 patients.

Conclusion:  In our experience 9.3% of patients awaiting renal transplant required intervention for aortoiliac disease prior to transplantation.  This incidence of clinically relevant vascular lesions, especially in older, male recipients, suggests that it may be beneficial to proactively investigate for the presence of aortoiliac disease and intervene when appropriate.