Management of peripheral vascular disease compromising renal allograft placement and function: review of the literature with an illustrative case

As the average age of a renal transplant candidate increases, the challenge of managing recipient vascular disease affecting renal allograft function will become more common. Pre-operative screening can reveal the presence of atheromatous disease that could adversely affect allograft transplantation and function, but parameters for successful screening have not been established. Treatment options include pre-operative revascularization, concurrent therapy or delayed revascularization. Endovascular therapies have burgeoned but surgical correction is still required for some of the more complex, long-segment lesions. Potential surgical interventions range from endarterectomy to aorto-iliac bypasses. We present a case of immediate post-operative revascularization using a femoro-femoral bypass to salvage a renal allograft. The literature is reviewed to assess best practices for detecting peripheral vascular disease in renal transplant candidates and subsequent management options.