J Korean Med Sci 2009; 24: 166-9 ISSN 1011-8934 DOI: 10.3346/jkms.2009.24.1.166 Copyright The Korean Academy of Medical Sciences Abdominal Aortic Aneurysm Repair in Patient with a Renal Allograft: A Case Report Renal transplant recipients requiring aortic reconstruction due to abdominal aortic aneurysm (AAA) pose a unique clinical problem. The concern during surgery is caus- ing ischemic injury to the renal allograft. A variety of strategies for protection of the renal allograft during AAA intervention have been described including a temporary shunt, cold renal perfusion, extracorporeal bypass, general hypothermia, and en- dovascular stent-grafting. In addition, some investigators have reported no remark- able complications of the renal allograft without any specific measures. We treated a case of AAA in a patient with a renal allograft using a temporary aortofemoral shunt with good result. Since this technique is safe and effective, it should be con- sidered in similar patients with AAA and previously placed renal allografts. Key Words : Aortic Aneurysm, Abdominal; Renal Allograft, Temporary Shunt INTRODUCTION Renal transplantation is a widely accepted treatment app- roach for an increasing number of patients with end-stage renal disease. Because of the improvement in immunosup- pressive therapy and management of patients after renal trans- plantation, long-term patient and renal allograft survival has improved. With the long-term renal allograft and patient survival, some patients develop secondary complications of systemic atherosclerosis, such as aortic aneurysmal or occlu- sive disease, necessitating operative intervention. In fact, many of these patients are at risk for accelerated atherogenesis due to their long-standing hypertension, uremia and other comor- bid factors. In renal allograft recipients, an abdominal aortic aneurysm (AAA) requiring surgical management may represent a truly life-threatening condition, and a more complicated repair. Aortic reconstruction with aortic cross-clamping places the renal allograft in the pelvis at risk for ischemic damage. To minimize this risk, several different operative strategies have been reported (1-8). We herein report our experience using a temporary shunt for AAA repair in a patient with a renal allograft. CASE REPORT A 40-yr-old man developed end-stage renal disease secon- Hyung-Kee Kim, Jong-Pil Ryuk, Hyang Hee Choi, Sang-Hwy Kwon, and Seung Huh Division of Transplantation and Vascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, Korea Received : 16 October 2007 Accepted : 19 January 2008 Address for correspondence Seung Huh, M.D. Division of Transplantation and Vascular Surgery, Department of Surgery, Kyungpook National University Hospital, 50 Samdeok 2-ga, Jung-gu, Daegu 700-721, Korea Tel : +82.53-420-6520, Fax : +82.53-421-0510 E-mail : shuh@mail.knu.ac.kr 166 dary to chronic glomerulonephritis that had been diagnosed 18 yr before. Thirteen years previously, he had undergone a living-related renal transplantation to the right iliac fossa without complications. The patient was maintained on pred- nisone and other immunosuppressants such as cyclosporine and mycophenolate mofetil. The transplanted kidney showed excellent function until the diagnosis of AAA. The serum creatinine level was within normal limits during the follow- up period. An abdominal ultrasound for the regular follow- up evaluation was performed in December 2005. The scan revealed an AAA, and subsequent computed tomography (CT) angiography showed an infrarenal AAA measuring 6.4 cm in diameter (Fig. 1). There was no radiographic evidence of leak or rupture. On preoperative evaluations, myocardial perfusion imag- ing at rest and under stress revealed an abnormal irreversible perfusion defect in the inferior and basal lateral wall. Coro- nary angiography showed a focal severe stenosis of the prox- imal left circumflex coronary artery. However, attempts to pass a balloon failed and he was maintained with medical treatment. After one month of medical management, he underwent an AAA repair with a tube prosthesis and a temporary aor- tofemoral shunt. Through a transperitoneal approach, the aorta was dissected up to the renal artery without renal vein division. A separate right groin incision was made to expose the common femoral artery. Because the proximal neck of his AAA was enough to place the temporary shunt, cannu-