Aim: Renal transplantation usually is performed via extraperitoneal approach and the graft is placed in iliac fossa. When iliac vessels are not appropriate for anastomosis, graft position can be changed. Here we report the long term follow up of a Buerger disease patient who had successful orthotopic renal transplantation through native renal artery and splenic vein.
Case: The case is a 68 years old male patient with chronic renal failure. He suffered from Buerger disease for 30 years and he had aorta-bifemoral bypass. Preoperative evaluation revealed that both iliac arteries (external and internal iliac) were obliterated in both sites. So, we decided to perform orthotopic renal transplantation from his relative. In the same session we performed native nephrectomy and orthotopic renal transplantation. The artery of the graft was anastomosed to native renal artery through PTFE graft. In the first attempt the vein of the graft was anastomosed to renal vein but venous outflow was inadequate. So venous anastomosis is displaced to splenic vein and spleno-renal anastomosis was done through PTFE graft. At the 10th day of operation he was discharged from hospital with normal creatine value (0,6 mg/dL). He still has normal graft functions with creatine value 1 mg/dL at the 30th month of the transplantation.
Conclusion: In cases with lack of vascular access for renal transplantation, alternative technically challenging vascular reconstruction techniques are described. Here we showed that splenic vein can be safely used for venous outflow of the graft without need for splenectomy.