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CASE 45: Inferior Epigastric Artery Reconstruction for an Upper Polar Accessory Transplant Renal Artery

Chelsea L Nielsen; Kevin S Butler; Nancy Kim; Elliot Grodstein; Ernesto P Molmenti

Small accessory upper polar transplant renal arteries rarely need to be reconstructed. In the case illustrated here, the donor kidney had a 1 mm upper polar artery supplying an estimated 15% of the renal parenchyma. The live donor was of small size (weight of the kidney was 160 grams) compared to the recipient (over 6 feet in height and greater than 200 lbs in weight). Both were of young age. The decision to reconstruct this artery was made after the kidney had been implanted and the size of the territory supplied by the accessory artery clearly identified. This is a technique to consider in instances of:

  • multiple donor arteries in kidneys from small donors being implanted onto big recipients

  • multiple donor arteries that are short and located far apart

  • An accessory artery supplying 15% or more of the renal parenchyma

FIGURE 112-189

The inferior epigastric artery (green arrow) is identified and dissected. Its branches are tied and transected. The rectus muscle is shown with a black arrow.

An intra-operative highlights the inferior epigastric artery. Surgical tools and a gloved hand are also shown on the site.
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FIGURE 112-190

An adequate length of the inferior epigastric artery (green arrow) is prepared, preserving its pedicle from the external iliac artery.

An intra-operative highlights the inferior epigastric artery being grasped vertically by a thread.
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FIGURE 112-191

The inferior epigastric artery (green arrow) and upper pole accessory transplant renal artery (yellow arrow) are shown. Note the ischemic territory supplied by the accessory upper pole renal artery (black arrow). Note that in this specific instance the kidney has a horizontal placement to prevent torsion of the transplant renal vein.

An intra-operative shows a surgical tool in contact with the inferior epigastric artery. The inferior epigastric artery being grasped vertically by a thread and the accessory transplant renal artery.
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FIGURE 112-192

The anastomosis between both arteries (green and yellow arrows) is constructed in an end-to-end fashion, in this case with interrupted sutures. The ischemic area of the renal parenchyma is shown with a black arrow)

An intra-operative shows the construction of anastomosis between the 2 arteries. The two arteries that are involved in the anastomosis and the ischemic area of the renal parenchyma. Surgical tools are shown in the site.
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FIGURE 112-193

Completed anastomosis (white arrow). Note that the upper pole of the kidney is now well perfused (black arrow). It is important to verify that the smooth configuration of the reconstructed artery is preserved at the time of closure of the abdomen.

An intra-operative highlights a well perfused transplanted kidney, after the anastomosis of the 2 arteries.
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