Anastomosis of dual renal transplant veins

Abstract

As there is usually considerable overlap in the renal venous drainage, it is often possible to ligate supernumerary transplant renal veins in order to simplify the implantation procedure. Nonetheless, decisions about whether to implant multiple veins can be difficult and are usually made subjectively. Here, we describe the use of intraoperative Doppler ultrasound as an adjunct to decision-making when there are two renal veins and a novel technique for the sequential anastomosis of dual veins. The kidney was reperfused after anastomosis of the main renal vein with the second vein clamped. On-table Doppler ultrasound demonstrated reversed flow in diastole indicating that the second renal vein also needed to be anastomosed. By clamping the external iliac vein inferior to the first venous anastomosis it was possible to complete the lower polar renal vein anastomosis to the external iliac vein without interrupting the perfusion of the kidney.

Venous reconstruction using a Y‐shaped saphenous vein in kidney transplantation: A report of three cases

“…Therefore, the effect of regional vein blockage is seemingly small 1 . In the case of multiple renal veins, the frequency of out‐flow block by sacrifice of remaining veins is unknown, but a method to check for congestion by Doppler ultrasound examination has been reported 2 …”

“…1 In the case of multiple renal veins, the frequency of out-flow block by sacrifice of remaining veins is unknown, but a method to check for congestion by Doppler ultrasound examination has been reported. 2 When transplanting the right kidney, it is unlikely that venous reconstruction will be necessary in most cases as the renal vein may be stretched due to its short length and blood flow in transplanted kidneys may be impaired. Most reconstructions often include end-to-side anastomosis with the external iliac vein.…”

“…1 In the case of living-donor renal transplantation, the donor left kidney is usually selected because the right kidney has shorter venous length than the left kidney. 2 If there are minor abnormalities in the donor right kidney, the normal donor left kidney is preserved. In these cases, the donor right kidney is tended to be used.…”

“…The shorter length of the allograft right renal vein is relevant to greater technical difficulty at a point of the venovenostomy. 2,3 When the allograft renal vein is short, one method is ample mobilization of the recipient's common and external iliac veins and/or lateralization of the external iliac vein to the external iliac artery. Another method is the use of vein grafts to extend the length of the allograft renal vein.…”

“…3 To lengthening the allograft short renal vein, some techniques have been performed, including a deceased donor's vena cava patch, a donor's or recipient's gonadal vein, a deceased donor's iliac vein, a superficial femoral vein graft, and a saphenous vein graft. [2][3][4] A saphenous vein graft is a good material, but the difference in the diameter of this vein as compared with the renal vein causes technical difficulties. 5 We previously mentioned renal vein lengthening using the saphenous vein in a case of short right allograft renal vein.…”