External iliac vein to inferior vena cava bypass as an alternative management for external iliac vein stenosis and thrombosis in renal transplant recipients

An man in his early 40s suffered from end-stage renal disease and underwent living donor renal transplantation. Doppler ultrasonography before surgery showed a normal iliac artery and vein without any thrombus. There was clear evidence of urine production intraoperatively. On the 5th postoperative d...

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Bibliographic Details
Published in:BMJ case reports 2022-05, Vol.15 (5), p.e245784
Main Authors: Hendarso, Muhammad Radityo, Ghinorawa, Tanaya, Aribowo, Haryo, Soerohardjo, Indrawarman
Format: Article
Language:English
Subjects:
Anticoagulants
Blood clots
Blood vessels
Case reports
Case Reports: Novel treatment (new drug/interventions
established drug/procedure in new situation)
Constriction, Pathologic - etiology
Constriction, Pathologic - surgery
Creatinine
Edema
Heart surgery
Hemodialysis
Humans
Iliac Vein - diagnostic imaging
Iliac Vein - surgery
Kidney - physiology
Kidney - surgery
Kidney diseases
Kidney Transplantation - adverse effects
Kidney transplants
Laboratories
Male
Thrombosis
Ultrasonic imaging
Veins & arteries
Vena Cava, Inferior - diagnostic imaging
Vena Cava, Inferior - surgery
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Summary:An man in his early 40s suffered from end-stage renal disease and underwent living donor renal transplantation. Doppler ultrasonography before surgery showed a normal iliac artery and vein without any thrombus. There was clear evidence of urine production intraoperatively. On the 5th postoperative day, there was no improvement in his renal function, and painless right leg oedema was noted. The clinical workup revealed pitting oedema without loss of arterial pulsation, discolouration or focal tenderness in the right leg. Serial Doppler ultrasonography examination showed thrombus progression from the right popliteal vein to the right external iliac vein around renal vein anastomosis despite anticoagulant administration with a downtrend of diuresis and worsening renal function. This condition led the patient to undergo surgical exploration on the 10th day post-transplantation. We decided to perform a thrombectomy and bypass the right external iliac vein to the inferior vena cava.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2021-245784