This is very handy technique to consider in instances of:
multiple donor arteries including lower polar arteries that frequently supply the ureter (Figure 112-276)
multiple donor arteries that are short and located far apart
a lower polar artery supplying 15-25% of the kidney parenchyma that either cannot be (Figure 112-277)
The allograft had a short main renal artery and a far apart narrow inferior polar artery (white arrow).
In situ dissection of the inferior epigastric artery (green arrow).
Confirm that the inferior epigastric artery of the recipient is of adequate size and quality (Figure 112-278)
Do not injure/divide the inferior epigastric pedicle (Figure 112-279)
Mobilize the inferior epigastric pedicle to a length that will allow a tension-free end-to-end spatulated anastomosis (Figures 112-280)
The inferior epigastric artery (green arrow) has been mobilized and transected at a location where it can comfortably reach the transplant kidney. Note that the area (blue arrow) supplied by the accessory lower pole artery shows poor perfusion.
Spatulated donor accessory lower polar (white arrow) and recipient inferior epigastric (green arrow) arteries inked blue for orientation and to prevent torsion. Both vessels are of similar diameter.
Completed anastomosis. Note that the lower pole of the kidney is now well perfused. It is important to verify that the reconstructed vessel curves around the peritoneum and has no kinks during closure.
P. Sequential anastomosis of accessory renal artery to inferior epigastric artery in the management of multiple arteries in live related renal transplantation: a critical appraisal. Clin Transplantation 2001; 15: 131–135. doi.org/10.1034/j.1399-0012.2001.150209.x
A. The use of inferior epigastric artery for accessary lower polar artery revascularization in live donor renal transplantation. Int Urlo Nephrol 2008; 40: 283–287. DOI 10.1007/s11255-007-9257-z