External iliac artery dissection during renal transplantation: a case report and literature review

Abstract Iliac artery dissection in the setting of renal transplant is a rare but potentially catastrophic event which may result in loss of kidney and lower extremity perfusion. We report a right external iliac artery dissection in a 45 year old male with end stage renal disease, diabetes and hypertension who underwent a renal transplant at our institution. An external iliac artery dissection was diagnosed intraoperatively following completion of the arterial anastomosis given mottled appearance of the kidney and loss of Doppler signal. The dissection was repaired via open endarterectomy, intimal tacking and bovine patch, and re-anastomosis of the kidney to a proximal site on the external iliac artery. To date, 23 cases of transplant related iliac artery dissection have been described in the literature. Predisposing risk factors include atherosclerosis and hypertension combined with trauma from vascular clamps or suturing. There is a slight male predominance. Only one group utilized an open endarterectomy approach similar to ours, while other authors chose synthetic vascular grafts (12 of 23), endovascular stents (4 of 23), donor iliac artery grafts (4 of 23) or saphenous vein grafts (2 of 23). In the absence of long-term outcome data, the optimal repair mechanism is not yet established.