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Online ISSN 1827-1847
Regina G., Ciavarella M., Grimaldi G., Impedovo G., Tempesta A. *, Carrieri G. *, Selvaggi F. P. *
From the Institute of Clinical Surgery II Chair of Vascular Surgery
* Department of Emergency Surgery and Organ Transplant Chair of Urology University of Bari, Italy
The use of kidneys with more than one artery or with an inadequate vascular system has become necessary over past years due to the increased demand for transplantation and the few donations made from cadavers. Various techniques have been used, also in view of the progress available by vascular surgery in recent years. In this study the authors summarise their experience of 260 kidney transplantations (175 from cadavers and 85 from living donors) performed between October 1973 and May 1999 at the Policlinico University Hospital, Department of Urology, University of Bari. This long period provided a useful means of evaluating the different surgical techniques used, the different forms of immunotherapy, the outcomes and the complications. Kidney revascularisation was achieved in 30 cases using an end-to-end anastomosis between the renal and hypogastric arteries; in 209 cases an end-to-side anastomosis was prepared with the external iliac artery using a small patch on the aortic wall where possible; in 20 patients, the anastomosis was created directly end-to-side with the common iliac artery and the host aorta. In one case an anastomosis was prepared using the splenic artery. Acute complications included three thromboses of the renal artery and two mycotic aneurysms. The chronic complications observed were an arteriovenous fistula and stenosis of the renal artery. Numerous possibilities have been described in the literature for the reconstruction of the arterial and venous system. For the sake of simplicity, it was chosen to illustrate these techniques using simple diagrams that surgeons who are preparing to carry out this type of operation will find easy to understand and remember.
language: English, Italian