INTRODUCTION: Complete inferior vena caval occlusion (IVC) with complete bilateral iliac vein (BIV) occulusion is a rare complication in patients with clotting diatheses. We present a technique for renal transplantation for a such a circumstance.

METHODS: The patient is a 33 year-old male with complete IVC occulsion from the level of the hepatic veins to both iliac venous systems. This was confiremd by pre-operative venography as well as magnetic resonance imaging (MRI). A suitable cadaveric renal donor became available. The operative approach was via a midline incision. A major tributory of the superior mesenteric vein (SMV) was dissected and used as a target for venous outflow. A venous extension graft was then fashioned to the SMV tributory and tunneled through the mesentary at the level of the third portion of the duodenum. An arterial extension graft was similarly fashioned to the iliac arterial system to facilitate allograft implantation in the right iliac fossa. The allograft was then brought into the surgical field and the vascular anastamoses were performed to both extension grafts. A standard running ureteroneocystomy was then performed.

RESULTS: The patient had immediate graft function. An early post-operative urinary fistula was controlled via extended foley catheter drainage. Post-operative ultrasonography and MRI showed patency of vascular anastamoses. The patient has been maintained on anticoauglation for his clotting diathesis with warfarin. With eight month follow-up the patient has a serum creatinine of 1.6 and has not required renal replacement therapy.

CONCLUSION: In these rare circumstances of complete IVC and BIV occulsion, renal transplantation with portal drainage is technically feasible. Complete IVC and BIV occulsion should not be a contra-indication to renal transplantation.

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