Endovascular iliac preparation for renal transplant using Viabahn stenting

Severe iliac calcifications may preclude standard renal transplantation (RT) because of hostile vascular access. We report a technique of iliac endovascular preparation using Viabahn stent-grafts (W. L. Gore & Associates) as arterial landing zones for RT in five high-risk patients. Endoclamping and arteriotomy and prosthotomy enabled direct anastomosis through the stent and artery. All grafts remained patent with no vascular complications or stenosis. This minimally invasive strategy avoids major bypass surgery and facilitates RT in patients previously considered ineligible. Although early outcomes are encouraging, strict patient selection and experienced surgical teams are essential. Larger studies are needed to validate long-term efficacy and safety.