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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 6  |  Page : 1137-1139
Congenital hypoplasia of the right common iliac artery in a renal transplant recipient


Renal Transplant Unit, Assad University Hospital, Damascus University, Syria

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Date of Web Publication4-Nov-2010
 

How to cite this article:
Al Midani A, Attar RA, Ahmad A, Othman M, Bargouth I. Congenital hypoplasia of the right common iliac artery in a renal transplant recipient. Saudi J Kidney Dis Transpl 2010;21:1137-9

How to cite this URL:
Al Midani A, Attar RA, Ahmad A, Othman M, Bargouth I. Congenital hypoplasia of the right common iliac artery in a renal transplant recipient. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2020 Oct 28];21:1137-9. Available from: https://www.sjkdt.org/text.asp?2010/21/6/1137/72308
To the Editor,

The vascular congenital malformation of iliac arteries are rare. [1],[2] It is extremely unusual in asymptomatic patients. [3],[4],[5],[6],[7],[8],[9],[10] We report a case of hypoplasia of the right iliac artery as an inci­dental finding of a patient with end-stage renal disease (ESRD), during the work up for a live related transplantation. A 44-year-old patient with ESRD of unknown origin and controlled hypertension. He was maintained on hemodia­lysis and prepared for living related kidney transplant. He never complained of claudica­tion or symptoms and signs of chronic ischemia in lower legs. His physical examination was unremarkable with good pulse bilaterally in the femoral, dorsalis pedis and posterior tibial arteries. An ultrasound Doppler scan was per­formed which revealed "absent right kidney and atrophy of the left one. It was difficult to study or asses the right iliac vein and artery with normal left sided vessels". A 64 multi­sliced CT angiogram was recommended to evaluate the vascular abnormality. The CT re­ported [Figure 1] and [Figure 2] as: The right lower limb, receives its perfusion from a dilated convoluted branch of the left internal iliac ar­tery that contains calcified atheroma. There is simultaneous hypoplasia of the right common iliac artery, which looks like short artery bi­furcating from the right side of the abdominal aorta, then it bifurcates to two convoluted ar­teries, which participate with the distal bran­ches in forming the main femoral artery. There is a compensatory dilatation of the common left iliac artery and its internal branch is seen. There are normal left common external and internal iliac veins. This patient received a live donor kidney from his relative, it was a right kidney with one artery and one vein, and was implanted into the left iliac fossa. The ap­proach was straightforward [Figure 3], the re­nal vein was anastomosed to the external iliac vein and the renal artery was anastomosed end to side to the external iliac artery. The kidney perfused nicely after releasing vascular clamps without compromising the blood supply to both lower limbs, the dorsalis pedis arteries were palpable bilaterally. The transplant sur­gery was uneventful and the kidney function improved quickly postoperatively with no symptoms or signs of leg ischemia, no bruit over the graft were identified. The patient was discharged home on day seven post-op with creatinine of 100 μmol/L. A follow-up ultra­sound scan and 64 muti-sliced CT was per­formed three months later [Figure 4].
Figure 1 :64 muti-sliced CT angiogram preoperatively, showing the hypoplasia of the right common iliac artery.

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Figure 2 : 64 muti-sliced CT angiogram preoperatively, showing the hypoplasia of the right common iliac artery.

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Figure 3 :Surgical site of left Iliac fossa, showing the external and internal left iliac arteries.

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Figure 4 :64 muti-sliced CT angiogram postoperatively, showing the vascular abnormality and the transplanted kidney on the left external iliac artery.

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Different malformations have been reported in the ilio-femoral area, including agenesis of an external iliac artery, congenital bilateral aplasia of external iliac arteries, congenital ab­sence of common iliac artery, absence of a uni­lateral internal iliac artery, quadrifurcation of the terminal aorta where all four iliac arteries arose separately from the aorta, and congenital absence of the common iliac artery with lower limb blood supply arising from the ipsilateral renal artery. Most of these cases were either symptomatic or had other congenital abnor­malities. [3],[4] In our case the patient was asymp­tomatic with no claudication and no signs of hypoperfusion in the right lower limb, such as different size of both legs, pulses were pal­pable bilaterally. It is likely that the hypoplasia of the right common iliac artery observed in our patient is congenital, regarding the promi­nence of the collateral vessels. [4]

There is no history of previous trauma to the right iliac arteries to suggest traumatic throm­bus formation. Furthermore, it is unlikely that the imaging findings are due to fibromuscular dysplasia. Although, this is more common in younger patients, fibromuscular dyplasia often has a beaded appearance on imaging. Further­more, all other vascular segments were normal in appearance. This dysplasia tends to involve more than one vascular segment. [7]

Although our patient is currently asymptoma­tic, hypoplasia of the right common iliac artery may pose a problem in the future in the setting of atherosclerosis and thrombosis of the ab­normal collaterals. [8]

We recommend routine ultrasound Doppler of the pelvic vessels for all renal transplant recipients, even those with no high risk of atherosclerosis of the iliac arteries or femoral vein thrombosis secondary to femoral line in­sertion for acute dialysis. The incidental fin­ding, thanks to the Doppler scan of unusual vessels, resulted in obtaining CT angiogram. Moreover, we emphasize the need of perfor­ming routine ultrasound Doppler scan of the pelvic vessels for all renal allograft recipients, and CT angiogram in case of high suspicion of athersclerosis of the internal iliacs or abnormal anatomy of the iliac vessels in order to plan site of surgery, and the vessels that should be used to have good results.

 
   References Top

1.Greebe J. Congenital anomalies of the ilio­femoral artery. J Cardiovasc Surg (Torino) 1977;18(3):317-23.  Back to cited text no. 1
    
2.Williams ZS, Rutter P. Bilateral congenital absence of internal iliac arteries, prominent arteries, and ruptured mycotic aneurysm of abdominal aorta. Ann R Coll Surg Engl 2006; 88(4):356.  Back to cited text no. 2
    
3.Harikrishnan S, Krishnamoorthy KM, Tharakan JM. Congenital bilateral aplasia of external iliac arteries. Int J Cardiol 2001;80:85-6.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Koyama T, Kawada T, Kitanaka Y, et al. Con­genital anomaly of the external iliac artery: a case report. J Vasc Surg 2003;37:683-5.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Llauger J, Sabate JM, Guardia E, Escudero J. Congenital absence of the right common iliac artery: CT and angiographic demonstration. Eur J Radiol 1995;21:128-30.  Back to cited text no. 5
    
6.Dabydeen DA, Shabashov A, Shaffer K. Con­genital absence of the right common iliac artery. Radiology case reports. Radiol Case Rep [Online] 2008;3:47.  Back to cited text no. 6
    
7.Oduro GD, Cope LH, Rogers IM. Case report: lower limb arterial blood supply arising from the renal artery with congenital absence of the ipsilateral iliac arteries. Clin Radiol 1992;45 (3):215-7.  Back to cited text no. 7
    
8.Dumanian AV, Frahm CJ, Benchik FA, Wooden TF. Intermittent claudication secondary to con­genital absence of iliac arteries. Arch Surg 1965;91(4):604-6.  Back to cited text no. 8
    
9.Harb Z, William S, Rutter P. Bilateral conge­nital absence of internal iliac arteries, pro­minent lumbar arteries, and a ruptured mycotic aneurysm of the abdominal aorta. Ann R Coll Surg Engl 2006;88(4):W3-5.  Back to cited text no. 9
    
10.Koyama T, Kawada T, Kitanaka Y, et al. Con­genital anomaly of the external iliac artery: a case report. J Vasc Surg 2003;37(3):683-5.  Back to cited text no. 10
    

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Correspondence Address:
Ammar Al Midani
Renal Transplant Unit, Assad University Hospital, Damascus University
Syria
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PMID: 21060190

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