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  • 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.

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