Objective  To determine whether the change from the Leadbetter‐Politano technique to a stented extravesical technique for the vesico‐ureteric anastomosis in renal transplantation has altered the incidence of urological complications. Patients and methods  Data were retrieved from a prospective computerized database and by case‐note review on 248 consecutive renal transplants performed between January 1990 and June 1996. The characteristics of the donor, recipient and organ were noted, together with the technique used for the vesico‐ureteric anastomosis and the occurrence of major and minor urological complications. Results  The Leadbetter‐Politano technique was used in 140 transplants and the stented extravesical technique in 108. There were no significant differences in the donor, recipient or organ characteristics between the groups. The stented extravesical technique was associated with a significantly lower rate of major complications (<2%) and clinically significant haematuria than with the Leadbetter‐Politano technique. Conclusion  Changing from the Leadbetter‐Politano technique to a stented extravesical technique for the vesico‐ureteric anastomosis has been a major factor in reducing the incidence of urological complications in our transplant practice.

This procedure should be considered before resorting to a prosthetic graft for vascular access.

NHBD kidneys are a valuable additional source of organs for transplantation, with long-term survival, comparable to transplants from HBD.

A prospective study of all patients with critical limb ischaemia (CLI) who presented to a single vascular unit was undertaken for a 12-month period. There were 222 referrals in 188 patients, 80.2 per cent of which were emergency or urgent admissions. The majority (72.5 per cent) were initially investigated with colour duplex scanning to characterize the arterial lesion. Diagnostic angiography was performed in 35.1 per cent. An attempt at revascularization was made in 73.0 per cent of cases using percutaneous transluminal angioplasty (PTA) in 42.3 per cent, surgery in 24.3 per cent, and a combination of surgery and PTA in 6.3 per cent. Primary major amputation was required in 22 cases (9.9 per cent) and conservative treatments were used in 38 (17.1 per cent). The in-hospital mortality rate was 10 per cent with a limb salvage rate of 79 per cent. Diabetes was an independent risk factor for amputation (odds ratio 2.4, 95 per cent confidence interval 1.22-4.79, P = 0.012). Median hospital stay was much shorter for patients treated by PTA (4.5 days) than surgery (16 days) or primary amputation (18 days). The complication rate of PTA requiring surgery was 5.5 per cent. CLI represents a large non-elective workload for a vascular unit. The increasing use of non-invasive duplex assessment and angioplasty plays a major part in the successful management of these patients.