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CASE 43: Iliac Artery Stenosis: Dorsal Oval Patch Repair

Alexia McCann-Molmenti; Santiago J Miyara; Sara Guevara; Ernesto P Molmenti

  • Small diameter recipient arteries can become stenotic due to a variety of reasons. One cause is when an aortic hole puncher used to create a round opening for implantation leads to an excessive loss of tissue. In such instances, the stenosis is usually appreciated after the transplant renal artery is already implanted.

  • The stenosis is resolved by incising the dorsal aspect of the stenosed artery (opposite to the site of implantation of the kidney) and augmenting it with a patch (vein from either the donor or the recipient, prosthetic material, bovine pericardium, other). This technique allows for repair of the stenotic area without having to remove and subsequently re-implant the kidney.

FIGURE 112-185

Schematic representation of a dorsal oval patch repair of a post-implantation stenosis of the recipient iliac artery. In this representation of one of our cases, the opening in the recipient iliac artery for implantation of the transplant renal artery was created with an aortic hole puncher. Because of the small diameter of the iliac artery, the amount of arterial wall removed by the punch was excessive, leading to a post-implantational stricture of the recipient artery. A dorsal oval venous patch resolved the stenosis.

2 illustrations depict stenosis in the recipient iliac artery and the repair process. The illustration on the left shows a T-shape, where the vertical section is labeled, transplant renal artery and the horizontal section is labeled, recipient iliac artery. An inward curved part of the recipient iliac artery is missing and is labeled, stenosis. The illustration on the right shows an oval patch attached to the missing part of the recipient iliac artery.
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