<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1646-706X</journal-id>
<journal-title><![CDATA[Angiologia e Cirurgia Vascular]]></journal-title>
<abbrev-journal-title><![CDATA[Angiol Cir Vasc]]></abbrev-journal-title>
<issn>1646-706X</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Angiologia e Cirurgia Vascular]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1646-706X2021000400339</article-id>
<article-id pub-id-type="doi">10.48750/acv.172</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Renal autotransplantation: a solution for different complex situations]]></article-title>
<article-title xml:lang="pt"><![CDATA[Autotransplante renal: uma solução para situações complexas diversas]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sousa]]></surname>
<given-names><![CDATA[Pedro Pinto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pinto]]></surname>
<given-names><![CDATA[Pedro Sá]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Machado]]></surname>
<given-names><![CDATA[Rui]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Almeida]]></surname>
<given-names><![CDATA[Rui]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Centro Hospitalar de Vila Nova de Gaia/Espinho Serviço de Angiologia e Cirurgia Vascular ]]></institution>
<addr-line><![CDATA[Vila Nova de Gaia ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Centro Hospitalar do Porto Serviço de Angiologia e Cirurgia Vascular ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>30</day>
<month>12</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>12</month>
<year>2021</year>
</pub-date>
<volume>17</volume>
<numero>4</numero>
<fpage>339</fpage>
<lpage>343</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S1646-706X2021000400339&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S1646-706X2021000400339&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S1646-706X2021000400339&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction:  Renal autotransplantation (RA) is a safe and effective procedure to reconstruct the urinary tract which first successful surgery was performed by Hardy in 1963. The main indications reported to perform a RA generally include renovascular disease, ureteral pathologies and neoplastic disease. Furthermore, RA may be useful as an ultimate recourse in preventing kidney loss in highly selected patients, especially when conventional methods have failed.  Materials and Methods:  The authors describe four total different situations where the RA was the key solution for the pathology initially presented. Clinical case I - A 52 years old male with a previous history of left nephrectomy due to a preceding exacerbation of his basal Crohn's disease and also a right ureter cutaneostomie, presented now with repetitive urinary tract infections that led to renal function impairment; Clinical case II - A 57 years old female with the diagnosis of renal artery aneurysm while being studied as a potential kidney donor; Clinical case III - A 49 years old male admitted in the emergency room after a penetrating trauma which conditioned bowel and ureteral lesions with postoperative consecutive and recurrent peritoneal infections that compounded a necessity for a left ureterostomy, that the patient vehemently refused; Clinical case IV - A 24 years old female with the diagnosis of Nutcracker syndrome identified after being studied regarding repetitive urgency admissions with frank haematuria.  Results:  Every patient was submitted to laparoscopic nephrectomy, ex-vivo reconstruction, if necessary, and kidney transplantation to the iliac fossa. The interventions were uneventful and only one patient faced a minor post-operative complication (surgical wound dehiscende). We performed an ultrasound and renal scintigraphy evaluation on following days after each procedure to attest normal renal perfusion.  Discussion:  The RA were conducted in two patients with ureteral cutaneostomie because there was no viable alternative but kidney loss. The other two clinical cases were treated with RA because they concerned a complex renovascular disease (one arterial and the other venous). Despite the existence of an endovascular option for these patients, long term follow-up studies are still lacking.  Conclusion:  The RA is a viable option in specific situations for kidney salvage. The recent development of laparoscopic nephrectomy significantly decreased the surgical hostility to the patient and promoted the RA as a value option for the treatment of complex vascular pathologies, traumatic disease and specific medical situations. It represents a credible alternative with attested results already described in the literature thus requiring a vast Institutional experience with conventional renal transplantation.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução:  O autotransplante renal (RA) é um procedimento seguro e eficaz, utilizado em patologias que requeiram reconstrução do trato urinário, cujo primeira intervenção foi descrita por Hardy em 1963. As principais indicações são doença renovascular, patologias ureterais e doença neoplásica. O RA poderá ainda ser útil em casos selecionados, como último recurso na prevenção de perda renal, especialmente quando os métodos convencionais não tiveram sucesso.  Materiais e métodos:  Os autores pretendem descrever quatro diferentes situações em que o RA foi a melhor solução para a patologia apresentada pelos doentes. Caso clínico I - Doente do sexo masculino, 52 anos de idade, com história de nefrectomia esquerda prévia e ureterostomia direita, no contexto de exacerbação da sua doença de Crohn. Apresentava-se agora, recentemente, com infeções urinárias de repetição e consequente disfunção renal; Caso clínico II - Doente do sexo feminino, 57 anos de idade, a quem foi diagnosticado um aneurisma da artéria renal enquanto era estudada como potencial dadora para transplante renal; Caso clínico III - Doente do sexo masculino, 49 anos de idade, admitido no Serviço de urgência vítima de trauma penetrante com atingimento abdominal e consequentes lesões ureterais e do trato intestinal. Submetido a laparotomia com reconstrução das mesmas, mas posteriores peritonites de repetição que condicionaram necessidade de ureterostomia que o doente recusava; Caso clínico IV - Doente do sexo feminino, 24 anos de idade, com o diagnóstico de Síndrome de Nutcraker após estudo realizado na sequência de admissão no Serviço de urgência com hematúria franca.  Resultados:  Todos os doentes foram submetidos a RA. As intervenções cirúrgicas decorreram sem intercorrências com apenas um doente a ter desenvolvido uma complicação (deiscência de ferida cirúrgica) no período pós-operatório. Foi realizado ecoDoppler e cintigrafia renal nos dias subsequentes ao procedimento que atestou a normal perfusão dos rins transplantados.  Discussão:  O RA foi realizado em dois doentes no contexto de lesões ureterais e perante a ausência de tratamento viável alternativo que não a perda do rim. Os outros dois casos ocorreram no contexto de patologias renovasculares complexas (uma arterial e outra venosa). Apesar da existência de opções endovasculares para estes casos, a publicação de resultados de seguimento a longo prazo ainda é escassa.  Conclusão:  O RA é uma opção viável em situações específicas em que é imperial a salvação do rim. Os avanços recentes com nefrectomia laparoscópica vieram reduzir de forma significativa a agressividade do procedimento cirúrgico, promovendo o RA como uma arma de tratamento de real valor no tratamento de patologias vasculares complexas, doença renovascular e ureteral traumática bem como situações médicas específicas. O RA representa assim, uma alternativa credível com resultados demonstrados e publicados, exigindo, contudo, ser realizado num Centro com elevada experiência institucional.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Renal auto-transplant]]></kwd>
<kwd lng="en"><![CDATA[laparoscopy]]></kwd>
<kwd lng="en"><![CDATA[Nutcracker syndrome]]></kwd>
<kwd lng="en"><![CDATA[Renal artery aneurysm]]></kwd>
<kwd lng="en"><![CDATA[Ex-vivo repair]]></kwd>
<kwd lng="pt"><![CDATA[Autotransplante renal]]></kwd>
<kwd lng="pt"><![CDATA[laparoscopia]]></kwd>
<kwd lng="pt"><![CDATA[Síndrome de nutcracker]]></kwd>
<kwd lng="pt"><![CDATA[Aneurisma da artéria renal]]></kwd>
<kwd lng="pt"><![CDATA[Reparo ex vivo]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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