Presentation
Potential kidney recipient.
Patient Data
The aorta has mild calcific plaque distally extending to bifurcation.
Common iliac arteries:
both arteries show mixed plaque posteriorly in their proximal 2 cm
right: plaque is mainly calcific and thin, with no significant lumen narrowing
left: plaque is mixed with 40% luminal narrowing over a length of 2.3 cm
distal parts of both vessels are normal and have a length of about 3.5 cm
Superficial femoral artery:
left side: short-segment critical ostia stenosis (80%) and severe diffuse narrowing proximally
right side: moderate diffuse disease
Incidental findings:
right external iliac vein shows contrast filling from anterior abdominal wall collaterals, indicating there is venous stenosis along the central drainage pathways from the upper limbs where contrast was injected
Case Discussion
It is desirable that the donor and the recipient have a genetic and immunological identity or at least a similarity. Usually, the transplanted kidney is placed in the contralateral iliac fossa; for example, the left kidney of the donor is customarily put in the right iliac fossa of the recipient. This site has been selected for many reasons. The segment of the ureter vascularized by the renal pedicle is short, and with the kidney in this position, the ureter can be implanted directly into the bladder, avoiding the problems of uretero-ureteric anastomosis. The internal iliac artery and external or common iliac veins are of sufficient size for successful anastomosis 1.
In addition, this site produces a proper anteroposterior relationship between the arteries and veins, and the ureter is directed to the bladder without twisting. An end-to-end anastomosis is made between the internal iliac artery of the recipient and the artery of the donated kidney. The vein of the transplanted kidney is anastomosed end-to-end with the common or external iliac vein of the recipient. Supplemental renal arteries, if present, are anastomosed with branches of the internal iliac artery.
Successful transplantation is greatly facilitated if the renal artery and vein are single and of adequate length and caliber 2.
Variations in the development of the renal vascular pedicle are frequent, as are divergences in the level of origin of the renal arteries and in their number and length. The number and location of the renal veins are also subject to variation. Supplemental veins are not as great a source of difficulty as the arteries because of the existence of intra-renal anastomoses, whereas sacrifice of a supplemental renal artery will result in infarction of a portion of the kidney 3. The incidence of arterial anomalies is significantly increased in cases of renal ectopia, fusions, malrotations, and hydronephrosis.
In addition to the developmental variations, unsuspected arterial diseases, such as fibromuscular hyperplasia, renal artery stenosis, renal artery aneurysm, and atheromatous plaque form action at the ostium of the renal artery, may be detected.
Unable to process the form. Check for errors and try again.