Application of homograft for intraoperative severe atherosclerotictic iliac vessel finding in renal transplantation: A case report

INTRODUCTION: Severe atherosclerosis is a complicated condition in chronic kidney disease (CKD) and could lead to the operation’s failure, when it was not detectable by pre-operative diagnostic imaging. Several methods including two-stage approach, synthetic graft, stent… have been reported, but complications (i.e. infection, graft rejection) are a matter of concern. The aim of this case is to provide the one-stage approach, in which renal transplantation and vascular reconstruction using fresh homografts from one brain-dead donor were used. PRESENTATION OF CASE: We reported a case of a 33-year-old male, who was diagnosed with CKD caused by chronic glomerulonephritis since the age of 28 and had been on hemodialysis. Not until did the transplantation take place that the operation team spotted the atherosclerotic external iliac artery, and vessel graft from the same donor was used and the renal was transplanted. The patient was discharged 14 days after the surgery without any complications. DISCUSSION: Kidney transplantation has revolutionized the life of patients with end-stage renal disease (ESRD). Around 6% of patients have severe atherosclerosis and the figure is increasing. Vascular degradation in ESRD might lead to unsuccessful operation. One-stage approach (including renal transplantation and external iliac artery replacement) using homograft from one doner is feasible to handle the situation. CONCLUSION: Severe atherosclerosis often accompanies with CKD. The difficulties of doing arterial anastomosis increases, which requires advanced techniques to deal with. Surgeons should be prepared about this circumstance. One-stage approach using one donor’s homografts, is a possible and safe procedure.