Successful renal vein reconstruction with bovine arterial heterografts

Surgical Stapler for Right Renal Vein Elongation Using the Inferior Vena Cava in Kidney Transplant

Elongation of the right renal vein with the inferior vena cava (caval patch) using a vascular stapler offers a safe means of extending the deceased-donor right renal vein, while minimizing the ischemic time of the kidney during preparatory dissection. The aortic patch of the right renal artery also can be preserved, which minimize the danger of arterial stenosis, kinking, and dissection.

Right renal vein elongation with the inferior vena cava for cadaveric kidney transplants: an old neglected surgical approach

INTRODUCTION

Short right renal vein is a frequent and well-known technical inconvenience that is commonly observed during transplantation of the right kidney. We present our experience with the elongation of short cadaveric right renal veins using the contiguous vena cava during cadaveric renal transplants.

METHODS

We performed 34 kidney transplantations with a short right renal vein requiring elongation using the inferior vena cava, to make the venous anastomosis technically feasible. The elongated right renal vein was anastomosed end to side to the external iliac vein in 24 patients, to the common iliac vein in 8 patients and to the inferior vena cava in 2 patients. The right renal artery with an aortic patch was implanted end to side in 33 patients, and end to end without aortic patch to the internal iliac artery in one patient.

RESULTS

In all cases, the vascular anastomoses were easily performed in the recipient and no thrombosis was observed.

CONCLUSION

Elongation of a short right renal vein with the inferior vena cava is a feasible mean to overcome technical problems that may compromise the results of cadaveric renal transplantation.

Use of vena cava to obtain additional length for the right renal vein during transplantation of cadaveric kidneys

During cadaveric organ harvesting removal of the right renal vein and a segment of the vena cava may facilitate venous anastomosis of the right kidney. The technique to obtain adequate length of the right renal vein using the vena cava is simple, physiological and effective. A segment of the inferior vena cava should be harvested with the right but not necessarily with the left kidney. The use of a long segment of vena cava makes the renal transplantation much easier and does not interfere with multiorgan procurement. The method is most useful when the right renal vein is extremely short or when the recipient has a large abdomen and a deep pelvis.

Successful renal vein reconstruction with a polytetrafluoroethylene vascular graft in kidney transplantation

Very frequently, technical difficulties make renal transplantation difficult and, on occasion, impossible. Problems with short renal veins are a classic example. We have successfully repaired two exceedingly short donor renal veins of equal size using two short polytetrafluoroethylene vascular grafts interposed between the renal veins and the recipient's iliac vein. So far, the kidney has functioned normally except for one minor episode of rejection.

Late changes in a bovine graft.--A case report

We treated a Japanese man with aneurysmal dilatation of the bovine graft transplanted for femorofemoral bypass. The reconstruction was performed successfully by the replacement with a Dacron graft 29 months after the first operation. Aneurysmal dilation was observed over the entire length of the graft, and the wall of the graft was fragile. Disruption of collagen fibers and bleeding into the graft wall from the arteries which had been newly formed in abundance were extensive. The histological findings suggested that bovine grafts should be used for only a short period or for the replacement of small arteries.