Ovarian vein bypass for renal allograft salvage in iliac vein atrophy: A case report and review of literature

Table 1 Timeline of the patient’s clinical course

Time point	Event	Detail
10 years before transplantation	Diagnosis of end-stage kidney disease	The patient was diagnosed with end-stage kidney disease and later required renal replacement therapy
9 years before transplantation	Initiation of hemodialysis and development of vascular complication	Maintenance hemodialysis was initiated. Placement of a right groin dialysis catheter resulted in vascular perforation requiring emergency laparotomy and vascular repair. Temporary dialysis via a left groin catheter was performed before conversion to a permanent arteriovenous fistula
6 months before transplantation	Parathyroidectomy	The patient underwent parathyroidectomy for severe hypercalcemia during long-term dialysis
Preoperative evaluation	Transplant work-up	Immunologic evaluation showed negative anti-HLA antibodies and negative crossmatch with a 2/6 HLA match. Preoperative creatinine was 771.7 µmol/L. Imaging was initially interpreted as showing no major iliac vascular abnormality, and the patient was scheduled for left iliac fossa transplantation
Day 0 (Intraoperative management)	Kidney transplantation and intraoperative finding	Living-donor kidney transplantation was performed. Intraoperative exploration revealed a markedly hypoplastic left external iliac vein (3 mm), resulting in severe venous outflow mismatch with the 12-mm graft renal vein
Day 0 (Transplantation)	Venous outflow reconstruction	A bypass from the renal vein to the ipsilateral ovarian vein was created using a GSV interposition graft. After declamping, the graft immediately softened and urine output began within 1 minute
Early postoperative period	Initial graft function	Doppler ultrasonography showed excellent graft perfusion (resistive index: 0.56). Serum creatinine decreased to 51.3 µmol/L and was 53.9 μmol/L at discharge
Postoperative month 7	Clinical follow-up	Serum creatinine remained stable at 65.4 µmol/L with preserved graft function
Postoperative month 8	Imaging follow-up	Doppler ultrasonography demonstrated preserved corticomedullary differentiation, patent arterial anastomoses, and adequate venous outflow through the renal vein and GSV conduit. Magnetic resonance imaging confirmed patency of the 3 arterial anastomoses and the GSV-ovarian vein conduit

HLA: Human leukocyte antigen; GSV: Great saphenous vein.