Corner-Saving Renal Artery Anastomosis for Renal Transplantation

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Abstract

Introduction

Renal transplantation is the preferred treatment for most patients with end-stage renal disease. Postoperative vascular complications that significantly affect graft loss include renal artery stenosis and thrombosis. Many arterial anastomoses have been used at various transplant centers. Haberal described corner saving renal artery anastomosis in 2003. In this study, we have presented the long term outcomes of 459 renal transplant recipients to undergo our corner-saving renal artery anastomosis technique.

Materials and Methods

Our transplant team has performed 2646 procedures since 1975. After December 2003, we began using the corner-saving technique. When performing the corner-saving technique, before suturing, the posterior wall of the renal artery is spatulated approximately 2 to 3 mm. Then a 7-0 Prolene running suture is made beginning 3 mm ahead of the middle of the posterior walls of the renal artery and the external iliac artery, finishing at the anterior walls of the renal and external iliac arteries.). After the last stitch, both ends of the suture material are pulled to decrease the excess, and the posterior walls of the renal and external iliac arteries are approximated tightly. Then, 1 retraction suture is placed at the anterior corner of the external iliac and renal arteries. The remaining wall is sewn with the same suture.

Results

324 of the patients were male and 135 of the patients were female. Overall mean age of 31.3±8.9 years (range, 7–66 years); 339 of the patients were living donor kidney transplantation and 120 of the patients were deceased donor kidney transplantation. No renal artery thrombosis developed in any of our patients. In 2 patients iliac artery dissection occurred, and treated with surgical procedure. In 4 patient (0.8%), a renal arterial stenosis was noted at the follow up period. All of them were treated with interventional radiologic procedures. 32 patients passed away during the follow up period (Patient survival: 93%). All deaths occurred 1 year after transplant and all of them had normal renal functions.

Conclusion

With its low complication rates, we believe that the corner-saving suture technique is a safe and easy means of performing a renal arterial anastomosis that will decrease the rate of vascular complications. Spatulating the posterior wall of the renal artery provides a wider anastomosis.

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