CHAPTER 53: Implantation: Variants and Complications: Vascular

TRANSPOSITION OF THE EXTERNAL ILIAC VESSELS (FIGURES 53-1–53-5)

Ernesto P Molmenti

We routinely transpose the external iliac vessels, placing the vein lateral with respect to the artery.

The external iliac vessels (on the right side in the images below) are dissected and, at the time of implantation of the kidney, the external iliac vein is transposed to a position lateral with respect to the external iliac artery (Figures 53-1–53-5).

This approach has several advantages:

It allows for the anastomosis of shorter veins (such as right donor renal veins) without having to reconstruct them (such as with the use of donor IVC)

It prevents the transplant renal vein from being positioned on top of the recipient external iliac artery (potentially causing undesired stretching and external compression)

It allows for a more comfortable arterial anastomosis, without having to retract the renal vein (classically traveling on top of the external iliac artery) away from the field

It prevents the potential crossing over of the transplant renal vessels

IMPLANTATION INTO A RECIPIENT WITH PREVIOUS KIDNEY TRANSPLANTS

Ernesto P Molmenti

• In instances where the recipient had one or more previous transplants, we routinely obtain a computed tomography (CT) angiogram to outline the vascular status as well as the anatomy of the abdomen and pelvis.

• In instances of only one previous transplant:

  • Routinely place the kidney on the contralateral side

    • Unless there is a contraindication (such as inflow stenosis)

  • Do not remove the previous transplant:

    • Unless there is an indication (such as recurrent hematuria, infections, lesions)

    • When the previous transplant needs to be removed, we routinely remove it prior to the transplant and wait until the site has healed prior to proceeding with the new implantation.

• In instances ...