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

BACKGROUND: Failure of venous drainage during reperfusion is an uncommon but serious complication of kidney transplantation that can rapidly compromise graft viability. CASE SUMMARY: We report a 51-year-old woman with end-stage kidney disease undergoing living-donor kidney transplantation after long-term hemodialysis and prior left femoral dialysis catheterization. Intraoperatively, the left external iliac vein was unexpectedly found to be markedly atrophic, measuring only 3 mm, whereas the graft renal vein measured 12 mm. After initial anastomosis to the external iliac vein, reperfusion caused immediate graft congestion, indicating inadequate venous outflow. A short great saphenous vein interposition graft was therefore used to create an additional drainage pathway from the renal vein to the ipsilateral ovarian vein, which measured 3.7 mm. The graft decompressed immediately, and urine output began within 1 minute. Renal function remained stable, with a serum creatinine level of 65.4 μmol/L at 7 months, and 8-month imaging confirmed bypass patency and adaptive venous enlargement. CONCLUSION: A small ovarian vein with an autologous conduit can provide a salvage option for unexpected iliac venous pathology in kidney transplantation.