Cost of a delay

BMJ Case Rep. 2019 Apr 20;12(4):e228667. doi: 10.1136/bcr-2018-228667.

Abstract

Abandoning a renal transplant operation during a live-related transplant is a rare occurrence. We recently encountered a case of previously undiagnosed coarctation of aorta (CoA) in the recipient during surgery. This was diagnosed by the absence of femoral pulses, a Doppler scan showing monophasic flows bilaterally in the iliac arteries and a difference in the mean arterial pressure between the radial artery and iliac artery of 50 mm Hg. The donor and recipient surgery were abandoned. A CT aortogram was done on the recipient which showed a tight CoA. An angioplasty was performed and a bare metal stent placed for correction of CoA. After a week, transplantation was performed, and the patient made an uneventful recovery. This case highlights the importance of assessment of the peripheral pulses and noting a radiofemoral delay, which was missed in the preoperative assessment.

Keywords: hypertension; renal system; transplantation.

Publication types

  • Case Reports

MeSH terms

  • Angioplasty
  • Aortic Coarctation / complications
  • Aortic Coarctation / diagnosis*
  • Aortic Coarctation / diagnostic imaging
  • Aortic Coarctation / surgery
  • Delayed Diagnosis / adverse effects*
  • Female
  • Humans
  • Hypertension / etiology
  • Iliac Artery / diagnostic imaging
  • Iliac Artery / physiopathology
  • Kidney / blood supply
  • Kidney Transplantation*
  • Male
  • Preoperative Care
  • Time Factors
  • Tissue Donors
  • Transplant Recipients*
  • Ultrasonography, Doppler, Color
  • Young Adult