Kidney graft directly implanted on endovascular stent in external iliac artery; a preliminary experience

With an increasingly aging population, both end-stage renal disease and peripheral artery disease become more prevalent. Peripheral artery disease is increasingly treated with endovascular procedures. Endovascular stenting of the external iliac artery (EIA) is often considered a contraindication for kidney transplantation, as clamping of the artery could result in possible injuring of the stent. In this study, we describe our first two cases of kidney transplantation with a graft placed on a self-expandable metal stent and a covered stent as part of an endovascular repair of the aortic bifurcation, using endovascular balloon occlusion to occlude the proximal side of the EIA. Six months after transplantation, both recipients have good kidney function without any signs of ischemia of the ipsilateral limb. This study shows that it is feasible to place a kidney graft on an endovascular stent.