The anastomosis between renal polar arteries and arteria epigastrica inferior in kidney transplantation: an option to decrease the risk of ureter necrosis?

Ureteral necrosis after renal transplantation is often the result of impaired perfusion due to loss of donor polar arteries. A way of preserving polar arteries is their anastomosis with the A. epigastrica inferior. In three cases (aged 49‐, 58‐, and 63 years), 9.3% of 33 living donors, we detected d...

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Bibliographic Details
Published in:Transplant international 2001-12, Vol.14 (6), p.442-444
Main Authors: Wolters, H.H., Schult, M., Chariat, M., Senninger, N., Dietl, K.‐H., Heidenreich, S.
Format: Article
Language:English
Subjects:
Allograft
Anastomosis, Surgical
Biological and medical sciences
Epigastric Arteries - surgery
Humans
Kidney Transplantation - methods
Medical sciences
Middle Aged
Necrosis
Polar arteries
Renal Artery - surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
Transplantation
Ureter - pathology
Ureter necrosis
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Summary:Ureteral necrosis after renal transplantation is often the result of impaired perfusion due to loss of donor polar arteries. A way of preserving polar arteries is their anastomosis with the A. epigastrica inferior. In three cases (aged 49‐, 58‐, and 63 years), 9.3% of 33 living donors, we detected donor polar arteries on both sides, and anastomosed the polar artery to the A. epigastrica inferior with microsurgical methods. Intraoperatively, the flow was measured by flowmeter, in the postoperative course duplexsonography and MR‐angiography was performed. In all three cases we noted a bluish, ischemic parenchym mass of 10–25% of the kidney and ureter. It recovered immediately, however, after the polar artery had been reconstructed. Intraoperative measurement showed a high flow on the polar and the main renal artery. Duplexsonography and MR‐angiography documented a good flow on the A. epigastrica anastomosis. There have been no signs of ureteral problems at all. After a mean follow‐up time of 26 months, the mean creatinine level is 1.46 mg/ml. Ureteral necrosis after kidney transplantation is mostly the result of a lack of perfusion of the polar arteries of the lower kidney pole. If arteriosclerotic lesions inhibit an anastomosis with the renal artery, the anastomosis with the A. epigastrica inferior seems to be a useful alternative.
ISSN:0934-0874
1432-2277
DOI:10.1111/j.1432-2277.2001.tb00084.x