CASE 25: Segmental and Sub-Segmental Renal Arterial Defects

Deceased donor left kidney. The renal vein is shown with a yellow arrow.

Although there were 3 ostia (black arrows) in a common aortic patch, only 2 main renal arteries were identified.

The third artery (green arrow), transected at the time of procurement, was subsequently identified. Since it was of small diameter and one of the main arteries (red arrow) supplied the lower aspect of the kidney, it was decided not to perform a reconstruction.

View of the reperfused kidney. There is a demarcated area (arrows) in the upper posterior region of the kidney, probably representing sub-segmental involvement of the proximal aspect of the Posterior Segment.

The anterior aspect of the kidney shows good perfusion throughout.

The transected non-reconstructed artery is shown with a green arrow.

Diagram of the renal segments. The involved proximal area of the Posterior Segment is shown in black (arrow).

Post-op duplex Doppler US showed perfusion of the entire kidney

Post-op duplex Doppler US showed perfusion of the entire kidney

Donor. In this other instance, a live donor kidney showed a small artery (yellow arrow, approximately 1mm in diameter) to the upper pole. It was decided not to reconstruct it given its size and the fact that it did not supply the lower part of the kidney (and thus would not compromise the blood supply of the ureter).

Recipient. The recipient had a history of SLE and pulmonary embolism (high probability VQ scan) in the past. At the time of discharge developed tachycardia. A CT angiogram did not show PE. CT images extended to evaluate for DVT in the abdomen and lower extremities showed a small perfusion defect (green arrow) in the superior segment of the transplanted kidney corresponding to the non-reconstructed artery.

Renal segmental anatomy