C Croce

Endovascular repair of an aorto-left renal vein fistula due to a ruptured abdominal aortic aneurysm after EVAR.

Purpose: To report an unusual late complication of endovascular aneurysm repair: an arteriovenous fistula between the aneurysm sac and a retro-aortic left renal vein following sac expansion due to a type III endoleak. Case Report: A 79-year-old man developed an arteriovenous fistula between the aneurysm sac and a retro-aortic left renal vein 67 months after endovascular aneurysm exclusion (EVAR). Aneurysm rupture was due to disconnection between the right iliac limb and an extender cuff. The problem was repaired percutaneously with another endograft bridging the two prostheses. At 16 months, the aneurysm sac diameter was decreased; there was no evidence of the AV fistula, and the patient was free from any complication related to the EVAR. Conclusions: This case emphasizes the need of close surveillance even in the late postoperative course of these patients. Moreover, this rare event confirmed that endovascular techniques can play an important role in treating emergent complications.

Total Duodenectomy with Enteric Duct Drainage: A Rescue Operation for Duodenal Complications Occurring after Pancreas Transplantation

Duodenal graft complications (DGC) occur frequently after pancreas transplantation but rarely cause graft loss. Graft pancreatectomy, however, may be required when DGC compromise recipients safety. We herein report on two patients with otherwise untreatable DGC in whom the entire pancreas was salvaged by means of total duodenectomy with enteric drainage of both pancreatic ducts. The first patient developed recurrent episodes of enteric bleeding, requiring hospitalization and blood transfusions, starting 21 months after transplantation. The disease causing hemorrhage could not be defined, despite extensive investigations, but the donor duodenum was eventually identified as the site of bleeding. The second patient was referred to us with a duodenal stump leak, 5 months after transplantation. Two previous surgeries had failed to seal the leak, despite opening a diverting stoma above the duodenal graft. Thirty‐nine and 16 months after total duodenectomy with dual duct drainage, respectively, both patients are insulin‐independent and free from abdominal complaints. Magnetic resonance pancreatography shows normal ducts both basal and after intravenous injection of secretin. The two cases presented herein show that when DGC jeopardize pancreas function or recipient safety, total duodenectomy with enteric duct drainage may become an option.

Role of color Doppler sonography in post-transplant surveillance of vascular complications involving pancreatic allografts

PURPOSE To evaluate the role of color Doppler ultrasonography in the postoperative surveillance of the vascular complications involving pancreas allografts. METHODS A retrospective analysis of a consecutive series of 223 pancreas transplantations was performed. All recipients received antithrombotic prophylaxis, which was tailored to the individuals estimated risk of thrombosis. All patients were monitored with daily color Doppler ultrasonography during the first post-transplant week and thereafter whenever clinically indicated. Vascular complications were defined as all thrombotic events requiring: increased anticoagulant therapy, angiography with fibrinolytic therapy, or repeat surgery. RESULTS The overall patient survival rates at one, three, and five years after transplantation were 94.7%, 93.3%, and 91%, respectively. The overall graft survival rates at the same time points were 87.4%, 79.6%, and 75.6%, respectively. In 28 of the 223 cases (12.5%) graft thromboses were diagnosed with Doppler ultrasound within the first 10 days after transplantation. In 3 cases, graft pancreatectomies were performed because of a complete loss of blood flow in the parenchyma. An attempt to rescue the graft was made in 18 patients. Fourteen of these grafts were saved and are still functioning (77.7%); and 4 rescue attempts failed and the grafts were subsequently explanted (32.3%). CONCLUSION Color Doppler ultrasound is a suitable tool for postoperative surveillance of pancreas transplant recipients. Its use can lead to early diagnosis and timely treatment of vascular complications.

PANCREAS TRANSPLANT ALONE IN TYPE 1 DIABETIC RECIPIENTS WITH OVERT DIABETIC NEPHROPATHY: RENAL FUNCTION OUTCOME: 2378

U. Boggi1, F. Vistoli1, C. Croce1, S. Signori1, C. Moretto1, M. Del Chiaro1, G. Amorese2, M. Barsotti3, P. Marchetti4 1Azienda Ospedaliero-universitaria Pisana, U.O. Chirurgia Generale e Trapianti, Pisa/ITALY, 2Azienda Ospedaliero-universitaria Pisana, U.O. Anestesia e Terapia Intensiva, Pisa/ITALY, 3Azienda Ospedalierouniversitaria Pisana, U.O. Nefrologia e Dialisi con Trapianti, Pisa/ITALY, 4Azienda Ospedaliero-universitaria Pisana, S.V.D. Endocrinologia e Metabolismo dei Trapianti d’Organo e Cellulari, Pisa/ ITALY

OUTCOME OF PANCREAS TRANSPLANTATION WITH 5 YEARS FOLLOW-UP OR MORE: 2312

F. Vistoli1, C. Croce1, S. Signori1, C. Moretto1, M. Del Chiaro1, G. Amorese2, M. Barsotti3, P. Marchetti4, U. Boggi1 1Azienda Ospedaliero-universitaria Pisana, U.O. Chirurgia Generale e Trapianti, Pisa/ITALY, 2Azienda Ospedaliero-universitaria Pisana, U.O. Anestesia e Terapia Intensiva, Pisa/ITALY, 3Azienda Ospedalierouniversitaria Pisana, U.O. Nefrologia e Dialisi con Trapianti, Pisa/ITALY, 4Azienda Ospedaliero-universitaria Pisana, S.V.D. Endocrinologia e Metabolismo dei Trapianti d’Organo e Cellulari, Pisa/ ITALY