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FIGURE 112-292

Recipient with a history of long-standing occlusion of the IVC. Imaging studies showed a patent left external iliac vein with semi-circumferential calcifications along its dorsal area. As seen in this image, the iliac vein was surrounded by fibrotic tissue that increased the complexity of its dissection.

FIGURE 112-293

Rather than applying clamps proximally and distally (that would have crushed the venous calcifications, risking embolization and/or thrombosis), it was decided to apply a clamp on the anterior non-calcified area (blue arrow) of the vein. Note the calcified plaque (yellow arrows) visible through the wall of the posterior half of the vein.

FIGURE 112-294

The finalized venous anastomosis (green arrows) can be seen after reperfusion of the kidney. The transplant renal vein is shown with a black arrow.

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