Experience in Kidney Transplantectomy with Temporary Iliac Arterial Occlusion for Bleeding Control in Patients with High Cardiological Risk – A Case Report

Abstract

Introduction: Approximately 16% of transplanted kidneys require surgical removal which may occur in cases of graft intolerance syndrome, premature loss, chronic inflammation, recurrent infections and cancer. When indicated, the classic technique is the open nephrectomy that may represent mortality rates at around 6 to 14%, reaching as high as 38% in cases of the procedure. The objective is to report a case of renal transplantectomy with intraoperative use of an iliac intravascular balloon catheter to control bleeding in a high-risk patient. The information was through reviewing the medical record, photographic record during the procedure and reviewing the literature. Results: In this current case, the temporary occlusion of the iliac artery by a vascular balloon catheter proved to be effective in controlling bleeding during graft removal in a patient at high surgical risk. Conclusions: Mortality related to transplantectomy is high, especially in cases of acute indication for the procedure and blood loss is an independent factor associated with increased morbidity and mortality and hospital stay. In this sense, the intraoperative use of a transient iliac intravascular balloon catheter in the reported case allowed for the control of bleeding during a graft nephrectomy in a high-risk surgical patient. Thus, there was a shortening of the surgical time, decreased need for transfusion, and safe anesthetic management, showing itself as an alternative in cases where surgical removal of the graft must be performed urgently.