Successful renal transplantation using polytetrafluoroethylene (PTFE) in a patient with complete iliocaval thrombosis: A case report

Heterotopic renal transplant is a well-established technique providing reachable access to the iliac vessels and urinary bladder. Rarely though, surgeons may encounter patients with focal or diffuse vascular thrombosis which would require additional technical maneuvers to overcome such obstruction and prevent catastrophic complications. We present a case of a 43-year-old female with complete iliocaval thrombosis prior to transplant precluding a retroperitoneal approach wherein we used a long segment of synthetic graft as a bridge between the graft renal vein and infrahepatic vena cava. The graft had immediate function and follow-up ultrasound demonstrated patent vasculature. This case highlights the value of preoperative imaging and being surgically prepared for nontraditional sites of vascular anastomosis. Selection of venous drainage in such cases should provide adequate venous outflow minimizing the risk of thrombosis and subsequent graft failure.