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CASE 56: Inferior Epigastric Artery Reconstruction for a Lower Polar Accessory Transplant Renal Artery

Teresa C Rice; Surendra Shenoy

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)

    • anastomosed into the external iliac artery

    • safely reconstructed by other techniques.

FIGURE 112-276

The allograft had a short main renal artery and a far apart narrow inferior polar artery (white arrow).

An intra-operative highlights a narrow inferior polar artery in the allograft.
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FIGURE 112-277

In situ dissection of the inferior epigastric artery (green arrow).

An intra-operative highlights the dissection of the inferior epigastric artery.
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Technique:

  • Plan upfront

  • 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)

FIGURE 112-278

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.

An intra-operative shows the transplanted kidney highlights the inferior epigastric artery and an area with poor perfusion.
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FIGURE 112-279

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.

An intra-operative shows the transplanted kidney highlights the inferior epigastric artery and the spatulated donor accessory.
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FIGURE 112-280

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.

An intra-operative shows the well-perfused lower pole of the transplanted kidney.
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REFERENCES

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Kumar  A, Gupta  RS, Srivatsava  A, Bansal  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
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El-Shebiny  M, Abou-Elela  A, Morsy  A, Salah  M, Foda  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

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