Troubleshooting Complex Vascular Cases in the Kidney Graft: Multiple Vessels, Aneurysms, and Injuries During Harvesting Procedures

Hevia, Vital; Gómez, Victoria; Hevia, M Fernández; Lorca, Javier; Santiago, Marta; López-Plaza, J.; Álvarez, Sara; Diez, V.; Gordaliza, Cristina Gonzalez; Burgos, Francisco

doi:10.1007/s11934-020-0955-8

Cited by 4 publications

(3 citation statements)

References 26 publications

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“…While aortic-venous connections in the kidneys generally remain asymptomatic, certain individuals may manifest symptoms including but not limited to heavy hemorrhage, abdominal whooshing, heart failure, hypertension, or abdominal discomfort. Depending on the dimensions of these connections, imaging tests may fail to detect them at times [21]. This figure is a republished image, permission was obtained from the original publisher, https://epos.myesr.org/poster/esr/ecr2018/C-2802…”

Section: Vascular Pathologiesmentioning

confidence: 99%

Renal Sinus Pathologies Depicted by CT Imaging: A Pictorial Review

Bolocan,

Diaconu,

Secareanu

et al. 2024

Cureus

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Diverse conditions comprise the spectrum of renal sinus pathologies, which have diagnostic and therapeutic implications for patients. Using CT imaging as a lens, this exhaustive review examines the representation of these pathologies. The article begins with a concise synopsis of renal anatomy and the specialized CT methodologies utilized to achieve excellent visualization. Transformational cell carcinoma, leiomyosarcoma, renal cell carcinoma, multilocular nephroma, and lymphoma are among the tumoral origins of the renal sinus pathologies that are investigated. Further, vascular pathologies including fistulas, hematomas, and aneurysms are included in the discourse, along with parapelvic and peripelvic cysts, and lipomatosis. In addition to urolithiasis and encrusted uretero-pyelitis, the review examines the consequences of metal toxicity and non-neoplastic conditions. With a focus on critical CT imaging findings that aid in the provision of an accurate diagnosis, every pathology is meticulously examined. With the intention of improving clinical decision-making and patient care, this article intends to function as a valuable resource for radiologists, clinicians, and researchers who are engaged in the interpretation and comprehension of renal sinus pathologies.

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Section: Vascular Pathologiesmentioning

confidence: 99%

Renal Sinus Pathologies Depicted by CT Imaging: A Pictorial Review

Bolocan,

Diaconu,

Secareanu

et al. 2024

Cureus

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“…With a widening gap between supply and demand of organs, living-donor kidney transplantation (LDKT) has substantially increased in efforts to expand the donor pool. This has led to a surge in living-donor kidneys (LDK) with anatomical variations, specifically, multiple renal arteries (MRA) ( 1 , 2 ). Kidneys with MRA are common in renal vascular anatomy, occurring at an incidence of 18–43% in potential kidney donors ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Creating a Single Inflow Orifice From Living Donor Kidney Allografts With Multiple Renal Arteries

et al. 2022

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Background: Multiple renal arteries (MRA) are often encountered during living-donor kidney transplantation (LDKT), requiring surgeons to pursue complex renovascular reconstructions prior to graft implantation. With improvements in reconstruction and anastomosis techniques, allografts with MRA can be successfully transplanted with similar outcomes to allografts with a single renal artery. Here, we describe in detail various surgical techniques for reconstruction of MRA grafts with the intent of creating a single arterial inflow.Methods: We retrospectively reviewed the medical records of all LDKT recipients with laparoscopically procured MRA kidneys between March 2008 and July 2021. Recipient and donor characteristics, operative data, type of reconstruction, and recipient outcomes were analyzed. The primary outcomes were the incidence of developing delayed graft function (DGF) and/or a vascular or urological complication within 12 months post-transplant.Results: Seventy-three LDKT recipients of MRA donor allografts were evaluated. Two renal arteries (RA) were encountered in 62 allografts (84.9%) and three RA in 11 allografts (15.1%). Renal artery reconstruction was performed in 95.8% (70/73) of patients. Eighteen different reconstruction techniques of MRA were utilized, the most common being side-to-side anastomosis in allografts with two RA (N = 44) and side-to-side-to-side anastomosis in allografts with three RA (N = 4). Interposition grafting was performed in seven cases (9.6%). A single ostium was created in 69 cases (94.5%), and the median warm ischemia time was 27 (range 20–42) minutes. None of the patients developed DGF or post-operative vascular or urological complications. Median creatinine at 3, 6, and 12 months post-transplant remained stable at 1.1 mg/dl. With a median follow-up of 30.4 months post-transplant, only one graft failure has been observed–death-censored graft survival was 98.6%.Conclusion: Complex reconstruction techniques to create a single renal artery ostium for graft implantation anastomosis in allografts with MRA show acceptable warm ischemic times, with no increased risk of post-operative vascular or urological complications.

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“…1 A number of techniques are available and the reconstructive options can be complex in the absence of an arterial aortic patch. [2][3][4][5] Here, we describe the use of a recipient internal iliac artery to create the equivalent of an aortic patch for the anastomosis of multiple renal arteries in live donor kidney transplantation.…”

Section: Introductionmentioning

confidence: 99%

Dealing with multiple renal arteries in live donor kidney transplants

Leighton

Hoff

Nicholson

et al. 2020

annals

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By performing this sequence of events, the narrow femur distal to the metaphyseal shaft junction is rasped first, which will help facilitate the 37.5mm No. 0 rasp and stem if required. This is demonstrated in figures 3 and 4.Being aware of this will help when dealing with proximal tight canal femurs to help minimise any untoward intraoperative complications and aid in the smooth, easy preparation of the femur. DISCUSSIONThis technique has proved effective and efficient in safely and adequately preparing the narrow femur to accept a more appropriate size stem in both total hip replacement and hemiarthroplasty. This technique does not require any extra equipment and is therefore cost neutral.

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Troubleshooting Complex Vascular Cases in the Kidney Graft: Multiple Vessels, Aneurysms, and Injuries During Harvesting Procedures

Cited by 4 publications

References 26 publications

Renal Sinus Pathologies Depicted by CT Imaging: A Pictorial Review

Renal Sinus Pathologies Depicted by CT Imaging: A Pictorial Review

Creating a Single Inflow Orifice From Living Donor Kidney Allografts With Multiple Renal Arteries

Dealing with multiple renal arteries in live donor kidney transplants

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