Academic Journal
Restoring Access to Kidney Transplantation: Midterm Outcomes of Pre-Emptive Aortobifemoral Bypass in Candidates with Severe Aortoiliac Disease.
| Τίτλος: | Restoring Access to Kidney Transplantation: Midterm Outcomes of Pre-Emptive Aortobifemoral Bypass in Candidates with Severe Aortoiliac Disease. |
|---|---|
| Συγγραφείς: | Chavent B; Vascular Surgery Unit, Clinique Générale d'Annecy, Annecy, France., Caradu C; Vascular Surgery Unit, Bordeaux University Hospital (CHU de Bordeaux), Bordeaux, France. Electronic address: caroline.caradu@chu-bordeaux.fr., Palmier M; Vascular Surgery Unit, CHU de Rouen, Rouen, France., Millon A; Vascular Surgery Unit, Lyon University Hospital (Hospices Civils de Lyon), Lyon, France., Arsicot M; Vascular Surgery Unit, Lyon University Hospital (Hospices Civils de Lyon), Lyon, France., Favre JP; Saint-Étienne University Hospital (CHU de Saint-Étienne), Vascular Surgery Unit, Saint-Étienne, France. |
| Συλλογικό Έργο: | AURC Collaborators |
| Πηγή: | Annals of vascular surgery [Ann Vasc Surg] 2026 Aug; Vol. 129, pp. 255-264. Date of Electronic Publication: 2026 Apr 27. |
| Τύπος έκδοσης: | Journal Article; Multicenter Study; Observational Study |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Country of Publication: Netherlands NLM ID: 8703941 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1615-5947 (Electronic) Linking ISSN: 08905096 NLM ISO Abbreviation: Ann Vasc Surg Subsets: MEDLINE |
| Imprint Name(s): | Publication: <2007->: Netherlands : Elsevier Original Publication: Detroit : [Published by Expansion scientifique française for Annals of Vascular Surgery, Inc. and Association pour la promotion de la chirurgie vasculaire, Paris, c1986- |
| Ιατρικοί όροι (MeSH): | Aortic Diseases*/surgery , Aortic Diseases*/diagnostic imaging , Aortic Diseases*/mortality , Aortic Diseases*/physiopathology , Arterial Occlusive Diseases*/diagnostic imaging , Arterial Occlusive Diseases*/surgery , Arterial Occlusive Diseases*/mortality , Arterial Occlusive Diseases*/physiopathology , Blood Vessel Prosthesis Implantation*/adverse effects , Blood Vessel Prosthesis Implantation*/mortality , Iliac Artery*/surgery , Iliac Artery*/diagnostic imaging , Iliac Artery*/physiopathology , Kidney Transplantation*/adverse effects , Kidney Transplantation*/mortality , Vascular Calcification*/diagnostic imaging , Vascular Calcification*/surgery , Vascular Calcification*/mortality , Vascular Calcification*/physiopathology , Waiting Lists*/mortality, Femoral Artery/surgery ; Femoral Artery/physiopathology ; Femoral Artery/diagnostic imaging ; France/epidemiology ; Postoperative Complications/mortality ; Postoperative Complications/etiology ; Aged ; Female ; Humans ; Male ; Middle Aged ; Belgium ; Hospital Mortality ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Time Factors ; Treatment Outcome ; Vascular Patency |
| Περίληψη: | Background: Severe aortoiliac calcification and occlusive disease may preclude safe arterial clamping and anastomosis during kidney transplantation (KT), particularly as KT candidates age and accumulate comorbidities such as diabetes and peripheral arterial disease (PAD). Pre-emptive aortobifemoral bypass (ABFB) can restore durable inflow; however, multicenter data describing subsequent transplant access and outcomes stratified by symptom status remain limited. Methods: This retrospective multicenter cohort study was conducted across 12 French and 1 Belgian center between 1984 and 2017. Patients undergoing elective ABFB as part of pretransplant vascular assessment prior to (re)listing or waiting-list reactivation were included and stratified as asymptomatic (Rutherford 0-1) or symptomatic (Rutherford 2-5). The primary endpoint was access to KT (proportion transplanted and time from waiting-list reactivation to KT). Secondary endpoints included primary and secondary bypass patency, freedom from reintervention, perioperative major complications, survival, and pre-KT mortality. Results: A total of 129 patients were included (mean age 57 years; 85% male; 88% on dialysis). Thirty-day and in-hospital mortality was 1.6% (n = 2), and major 30-day complications occurred in 17.8% (n = 23). Median follow-up was 5.4 years. Preoperative imaging demonstrated severe external iliac calcifications in 77.5% of patients (n = 100); 9.3% (n = 12) had complete iliac occlusions. Overall, 55% underwent KT (n = 71). Median time from waiting-list reactivation to KT was 13 months (interquartile range [IQR]: 6-31) and was significantly shorter in asymptomatic PAD (11 months (IQR: 3-22) versus 21 months (IQR: 9-47); P = 0.006). Pre-KT mortality occurred in 9% (n = 11). Primary/secondary bypass patency was 95.8%/100% at 1 year and 90.8%/98.7% at 5 years, without significant differences by symptom status. Overall survival was 94.8% at 1 year and 79.5% at 5 years, favoring asymptomatic patients (1-/5-year 94.4%/92.1% vs. 95.2%/69.1%; log-rank P = 0.04). Secondary vascular procedures were required in 40% of patients. Conclusion: Pre-emptive ABFB enabled KT in over half of high-risk candidates with acceptable early risk and midterm patency. Symptomatic PAD identifies a higher-risk subgroup, supporting early vascular assessment and careful multidisciplinary selection. (Copyright © 2026 Elsevier Inc. All rights reserved.) |
| Entry Date(s): | Date Created: 20260409 Date Completed: 20260613 Latest Revision: 20260706 |
| Update Code: | 20260707 |
| DOI: | 10.1016/j.avsg.2026.03.057 |
| PMID: | 41956151 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1615-5947 |
|---|---|
| DOI: | 10.1016/j.avsg.2026.03.057 |