TRANSPOSITION OF THE EXTERNAL ILIAC VESSELS (FIGURES 53-1–53-5)
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
Transposed right external iliac artery and vein. The kidney is implanted once the vessels are transposed.
Transposed right external iliac artery and vein seen after implantation of the kidney. After the kidney is reperfused, all vessels lie in a comfortable position. Note the external iliac artery (yellow arrow) and vein (light blue arrow), as well as the transplant renal artery (white arrow) and vein (green arrow). As in all transplants, the kidney should be positioned in such a way so that the vessels and ureter lie without any twist, kinks, or compressions.
Kidney transplanted onto transposed right external iliac vessels. Note the transplant renal artery (green arrows) and vein (light blue arrows), the external right iliac artery (black arrows) and vein (blue arrows), and the transplant kidney (purple arrows).
IMPLANTATION INTO A RECIPIENT WITH PREVIOUS KIDNEY TRANSPLANTS
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:
In instances ...