Role of Intravascular Interventions in Simultaneous Pancreas and Kidney Transplantation - Almost 15 Years of Experience


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Abstract

IntroductionSince 2004 there has been 193 pancreas transplantations performed at the Department of Gastroenterological Surgery and Transplantation at the Central Clinical Hospital of the Ministry of the Interior in Warsaw. For almost 15 years we gained expertise in pancreas transplantation, developed surgical techniques, minimalized time of cold and warm ischemia of donor organs. Surgeons vascular skills determine the outcomes of the transplantation.Material and MethodsWe performed a retrospective analysis of all cases of pancreas transplantations performed in our clinic and chose those, who required non-standard for the procedure and most challenging vascular interventions.ResultsIn three cases we used intravascular procedure with implementing stent-grafts. In one retransplanted patient, there was acute extremity ischemia and narrowing in the iliac artery after previous transplantectomy.In other patient, the local inflammation after graftectomy lead to external iliac artery destruction at the side of former anastomosis and we observed acute severe bleeding. To perform hemostasis we had to implement a stent- graft to reconstruct the iliac artery wall. The third patient had a stent-graft implemented to femoral artery because of pseudoaneurysm of richt external iliac artery belowe pancreas graft vascular anastomoses.ConclusionsIntravenous interventions in pancreas transplanted and retransplanted patients are safe and feasible. It is a technically demanding procedure but the risks of kidney graft function deterioration, as well as bleeding due to high dose of heparin are lower than vascular surgery. Nevertheless, a multidisciplinary and experienced in vascular surgery surgical team is required.

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