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External iliac vein to inferior vena cava bypass as an alternative management for external iliac vein stenosis and thrombosis in renal transplant recipients
  1. Muhammad Radityo Hendarso1,
  2. Tanaya Ghinorawa1,
  3. Haryo Aribowo2 and
  4. Indrawarman Soerohardjo1
  1. 1Urology Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
  2. 2Thoracic and Cardiovascular Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
  1. Correspondence to Indrawarman Soerohardjo; indrawarman{at}


An man in his early 40s suffered from end-stage renal disease and underwent living donor renal transplantation. Doppler ultrasonography before surgery showed a normal iliac artery and vein without any thrombus. There was clear evidence of urine production intraoperatively. On the 5th postoperative day, there was no improvement in his renal function, and painless right leg oedema was noted. The clinical workup revealed pitting oedema without loss of arterial pulsation, discolouration or focal tenderness in the right leg. Serial Doppler ultrasonography examination showed thrombus progression from the right popliteal vein to the right external iliac vein around renal vein anastomosis despite anticoagulant administration with a downtrend of diuresis and worsening renal function. This condition led the patient to undergo surgical exploration on the 10th day post-transplantation. We decided to perform a thrombectomy and bypass the right external iliac vein to the inferior vena cava.

  • Transplantation
  • Urological surgery
  • Vascular surgery
  • Renal medicine
  • Renal transplantation

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  • Contributors MRH wrote the first draft and did literature research. The conception and design of the case report were conducted by MRH and IS. The article was critically revised for publication by MRH, IS, TG and HA. The patient was treated by TG, IS and HA.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.