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CASE 03: Arterial Twists and Kinks – External Stenting

Santiago J Miyara; Michael B Silva, Jr; Alexia McCann-Molmenti; Sara Guevara; H Colleen Silva; Luca Cicalese; Ernesto P Molmenti

  • We propose this technique (Figures 112-3 and 112-4) for cases where vessels have kinks/twists that compromise flow and do not resolve with other approaches such as placing a buttressing fat pad and/or repositioning the transplanted organ.

  • Our approach (developed by Michael B Silva Jr, MD) entails opening in a longitudinal fashion a ringed PTFE graft (or other type of graft that will retain its shape) and using it as an external stenting support placed around the kinked/twisted vessel.

  • Although in the diagrams we illustrate an external stenting of the iliac artery and of the transplant renal artery, this technique can be applied to any vessel individually.

  • When the stent encompasses the transplant renal artery anastomosis or a branching vessel, an opening in the PTFE graft should be made to account for such branching.

FIGURE 112-3
An illustration shows the lateral surface view of the transplanted kidney and the transplant renal artery. The common Iliac Artery and the external Iliac Artery are labeled. There is a kink in the renal artery and common Iliac Artery.
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FIGURE 112-4
An illustration shows the lateral surface view of the transplanted kidney and the transplant renal artery. The common Iliac artery and the external Iliac artery are labeled. Two PTFE Ringed grafts are labeled one each on the renal artery and the common Iliac artery.
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