The first successful surgery for giant renal artery aneurysm with autologous kidney transplantation

(Chinhphu.vn) – Doctors at the 108 Military Central Hospital have successfully treated a giant renal artery aneurysm at the renal hilum of a 37-year-old female patient from Phu Yen (old). During the surgery, the patient underwent an autologous kidney transplant. This is the first such case to be performed in Vietnam.

The first successful surgery for a giant renal artery aneurysm with autologous kidney transplantation - Photo: VGP/LH

From kidney preservation to patients

Previously, according to the patient, about 2 months ago, the patient had left lower back pain, sometimes with spasms, no spread, no fever. The patient went to many places for examination and was diagnosed with a giant aneurysm of the left renal artery at the renal hilum and was indicated for nephrectomy.

With the hope of having another treatment solution, the patient went to the 108 Military Central Hospital. Here, Dr. Ngo Vi Hai, Head of the Department of Thoracic Surgery, said that the patient had a giant aneurysm in the left renal artery measuring nearly 5cm in size and was in pain, a sign of a threat of rupture, so it needed to be treated early.

However, the difficulty of this surgery is that the aneurysm is located in the renal hilum, the arterial branches for the upper, middle, and lower renal calyces all originate in the aneurysm. In this case, the technique of placing a renal artery stent is not feasible. Reconstructing the renal artery to preserve the patient's kidney is a big challenge.

The patient recovered well, was able to take care of himself and walk again - Photo: VGP/LH

to the solution of kidney removal… and then transplant

Meanwhile, it is impossible to regenerate and repair this aneurysm while the kidney is still inside the body. With this damage, it is impossible to repair it with only conventional vascular techniques. Therefore, doctors have proposed a solution to remove the kidney, regenerate the renal artery outside the body and then re-implant it.

With the goal of preserving the patient's kidney, doctors from two specialties: upper urology and vascular surgery, consulted and carefully discussed the options.

Finally, the treatment plan for the patient was agreed upon, which was laparoscopic nephrectomy, preserving the kidney using the kidney transplant technique. The process of renal artery reconstruction, removing the aneurysm using the autologous saphenous vein was performed outside the body. When the renal artery reconstruction was completed, the kidney was reimplanted into the ipsilateral iliac fossa using the conventional kidney transplant technique.

Opening treatment direction for patients with complex kidney damage

Sharing the process of implementing the surgery, Dr. Nguyen Viet Hai, Head of the Department of Upper Urology, 108 Military Central Hospital, said that vascular surgeons need time to recreate blood vessels in the renal artery, while the time of warm ischemia of the kidney should not exceed 20-30 minutes. In that case, it is necessary to protect the kidney according to kidney transplant techniques.

Regarding urology, we decided to remove the diseased kidney from the abdomen by laparoscopic surgery, bring the kidney out through the left iliac fossa, and at the same time take advantage of the left iliac fossa incision as a position to insert the transplanted kidney, after revascularization.

The nearly 4-hour surgery went smoothly, as planned. After the transplant, the patient's kidney function was good, with good blood flow (assessed by ultrasound and renal angiography). The patient recovered well, was able to take care of himself and walk. The patient did not need to use anti-rejection drugs or other immunotherapy because this was an autologous kidney transplant.

Currently, in the world there are very few cases of complex vascular treatment like this one and in Vietnam this is the first recorded case.

"The collaboration has allowed us to treat complex diseases that were previously impossible. This has created a lot of excitement in the work of the vascular and urological surgical team to create the success of this surgery, opening up future treatment directions for patients with complex kidney damage," Dr. Nguyen Viet Hai shared.

According to Dr. Ngo Vi Hai, this success represents a breakthrough in ideas, combining the strengths of many specialties to successfully treat the most complex diseases.

HM

Source: https://baochinhphu.vn/lan-dau-phau-thuat-thanh-cong-khoi-phinh-khong-lo-dong-mach-than-co-ghep-than-tu-than-102251010163922265.htm