Vascular anastomosis for pediatric renal transplantation a potential new strategy in low. Kidney transplantation is the renal replacement therapy of choice for those patients with end stage renal disease. We successfully treated a transplant renal artery pseudoaneurysm with covered stents, which resulted in wellpreserved renal function. During renal transplantation the standard vein anastomosis technique is an endtoside anastomosis performed between the graft renal vein and the recipients external iliac vein with an extraperitoneal approach. Postkidney transplantation external iliac artery stenosis. An endovascular stent was placed at the stenosis site. Introduction the presence of multiple renal arteries mra in prospective renal donors was once considered a relative contraindication to live donor renal transplantation ldrt. Research open access the impact of vascular anastomosis. Vascular anastomosis of the renal artery to the external or internal iliac artery and the renal vein to the external iliac vein is a critical part of transplant surgery, which should be completed. Alternatively, the renal artery can be anastomosed first and then the renal vein for kidney transplantation. Pdf kidney transplant anastomosis internal or external iliac artery. Kidney transplantation has become the preferred mode of treatment for patient with end stage renal disease esrd after incorporating into clinical practice in the 1960s.
Relatively less is known about the warm time associated with vascular anastomosis and early outcomes. Surgical approach to renal transplantation sm journals. Renal transplantation is the preferred treatment for most patients with endstage renal disease. When compared with either haemodialysis or peritoneal dialysis, transplantation confers major survival advantages as well as a better quality of life. Our transplant team has performed 1635 procedures since 1975. We conclude that cadaveric renal transplantation can be performed using clips for the vascular anastomoses. Methods a retrospective cohort of 298 consecutive solitary deceased donor kidney recipients from january 2006 to august 2012 was analyzed to examine the association between anastomosis time and delayed graft function need for dialysis and. Pdf the impact of vascular anastomosis time on early. Approximately half of stenoses occur at the anastomosis due to perfusion cannula injury, faulty suture technique, or reaction to suture material, with endtoend anastomoses having a higher risk of. We observed a case of transplant renal artery dissection induced by. The basic technique of a kidney transplant surgery involves vascular and ureteric anastomoses. Umbilical tape or large silk suture is then passed posterior to the. In particular, significant progress has been made with regard to methods of vascular anastomosis.
I am planning for renal transplantation with allograft placement in the left iliac fossa. Donor accessory renal artery can be anastomosed to main renal artery. Vascular complications after renal transplantation article pdf available in bratislavske lekarske listy 11111. Below is detailed the particular case of endtoside continuous arterial anastomosis with aortic patch, using nonreabsorbable 90 monofilament with curved nonspatulated needle. A retrospective cohort of 298 consecutive solitary deceased donor kidney recipients from january 2006 to august 2012 was. Pdf we compared the best technique for arterial anastomosis in kidney transplantation, endtoside anastomosis to the external iliac artery or. Transplant renal artery dissection is a rare and serious event that can cause allograft dysfunction and activation of the reninmediated renovascular hypertension. From the department of urology, queens university, kingston, and the department of surgery, university of toronto, toronto, ontario abstracta simple technique for performing the vascular anastomoses in renal transplantation is presented. Kidney transplantation rational approach to vascular anastomoses j. The type of arterial anastomosis created is dictated largely by the type of graft available. Outcomes of kidney transplantation by using the technique. Various approaches to kidney transplantation have been developed. The renal artery is anastomosed either endto side to the external iliac artery.
Cross clamp aorta above and below aortotomy site b. However, there is a lack of data on the outcomes of kidney transplantation by using this alternative approach. Vascular reconstruction in kidney transplantation clinics in surgery. Older transplant recipients, prone to peripheral vascular disease pvd, may have pseudortas with pvd involving their iliac system. Introduction the surgical technique for kidney transplantation has been well established. A consecutive series of 260 renal transplants was analysed to find the outcome of diflerent urterial anas tomoses. Analysis of outcome of endtoend and endtoside internal iliac. Interventional radiologic management of renal transplant. Vascular complications include renal artery stenosis and renal artery and renal vein thrombosis. The impact of vascular anastomosis time on early kidney transplant outcomes karim marzouk2, joseph lawen3, ian alwayn4 and bryce a kiberd1,4 abstract background.
Pdf vascular complications after renal transplantation. Peripheral vascular disease and renal transplant artery. During renal extraction, note the shape and size of the aortic patch and make the arteriotomy in the aorta the same size. Here, we report a rare experience of the simultaneous reconstruction of the external iliac artery caused by severe atherosclerosis with polytetrafluoroethylene vascular graft and renal transplantation in a 55yearold female. Relatively less is known about the warm time associated. Vascular anastomosis for pediatric renal transplantation. Many centers prefer the old and standard technique using endtoend anastomosis to the internal iliac artery, because dealing with complications such as postoperative renal artery stenosis is more difficult with the endtoside anastomosis due to the angle of anastomosis, although there is a higher likelihood of development of steal. For arterial anastomosis endtoside anastomosis to the external iliac artery is the preferred technique in deceased donors. There were no postoperative complications and the patient went home after 6 days in the hospital. Renal artery pseudoaneurysms after renal transplantation are extremely uncommon and are able to cause severe complications such as aneurysm rupture or renal allograft loss. Postoperative vascular complications that significantly affect graft loss include stenosis and renal artery thrombosis. Renal transplant surgical procedure surgical procedure sequence for patients pdf vascular anastomosis for paediatric renal transplantation and new strategy in lowweight children the technical aspects of rt in low. Renal artery anastomosis to internal or external iliac. Clinical relevancethe endtoside anastomosis technique described here, which is a preferred method in human medicine, was successful, providing an alternative to other renal transplantation techniques in dogs.
Renal transplantation with simultaneous aortoiliac. Additional studies are needed to determine whether any vascular anastomosis technique is preferable for use in dogs requiring renal. Transplant renal artery stenosis tras, first reported in 1966, still represents one of the most critical complications potentially leading to renal graft dysfunction, posttransplant hypertension, and graft loss. Refinement of the operative technique for renal transplantation has greatly reduced the rates of surgical complications, morbidity, and mortality in patients. Ultrasound can accurately depict and characterize many of the potential complications of renal transplantation and increasingly magnetic resonance imaging also facilitates this role. Drawings illus trate arterial anastomosis of a renal transplant with one renal artery. Control angiography showed full vascular patency, transplant renal artery and intrarenal arteries open, and the renal artery anastomosis distal to the stent figure 2.
Ultrasound imaging of liver and renal transplantation. We retrospectively analyzed 819 patients who underwent kidney transplantation between 1993 and 1997 to determine the contribution of pseudortas to renal transplant renovascular disease. Unexpected presentation and surgical salvage of transplant. There are multipl altern atives in artery anastomosis. Outcomes of kidney transplantation by using the technique of.
Studies on aortoiliac reconstruction for severe atherosclerosis with renal transplantation are limited. The first kidney transplantation took place in 1954 by murray. Arterial anastomoses in renal transplantation wiley online library. A total of 38 patients with endstage renal disease who received a kidney transplant from a deceased donor were randomized into two groups in order to undergo either endtoend anastomosis to the internal iliac artery or endtoside anastomosis to the external iliac artery. Renal artery anastomosis to internal or external iliac artery in kidney.
Ca daveric kidneys are typically harvested with an intact main renal artery. Complications of renal transplantation rsna publications online. Most cases are induced by percutaneous transluminal angioplasty, arteriosclerotic disease, or fibromuscular dysplasia. Extrarenal anastomosis site pseudoaneurysms are rare with a reported incidence of renal transplant surgical procedure surgical procedure sequence for patients venous anastomosis a. Our results on kidney transplantation in small children have considerably improved with the consistent use of the aorta and the distal caval vein to perform vascular anastomoses. These include acute arterialvenous thrombosis, arteriovenous fistula, renal artery stenosis, intra and extrarenal pseudoaneurysms. Most studies have found cold ischemic time to be an important predictor of delayed graft function in kidney transplantation. In renal transplantation, there is endtoside anastomosis of renal artery to external iliac artery and endtoend anastomosis of renal. Most transplant centers report that the results of kidney transplantation at present are much better when compared with previous decades. Vascular anastomosis for paediatric renal transplantation. Vascular complications after renal transplantation 87 a b c fig.
Vascular anastomosis of the renal artery to the external or internal iliac artery and the renal vein to the external iliac vein is a critical part of transplant surgery, which should be completed within an hour to minimize the potential deleterious effect of prolonged warm and cold ischaemic time on kidney allograft function. Multiple renal arteries, live donor renal transplant 1. Past, present and future with special references to the belgian history 9 homotransplantation in human using a kidney from a deceasedbrain trauma, 60yearsold donor dcd blood group b. Vascular anastomosis for paediatric renal transplantation and new strategy in lowweight children.
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