Inferior Epigastric Artery a Boon in Accessory Lower Polar Artery Revascularization in Renal Transplantation

Kabilan Saminathan; Balaraman Velayutham; Muthu Veeramani

doi:doi:10.11648/j.ijcu.20230701.11

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Inferior Epigastric Artery a Boon in Accessory Lower Polar Artery Revascularization in Renal Transplantation

Kabilan Saminathan, Balaraman Velayutham, Muthu Veeramani

Published in International Journal of Clinical Urology (Volume 7, Issue 1)

Received: 11 December 2022 Accepted: 3 January 2023 Published: 13 January 2023

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Abstract

Multiple renal arteries occur unilaterally and bilaterally in 23% and 10% of the population, respectively. During renal transplantation failure to recognize and preserve an accessory renal artery may lead to ureteral necrosis, segmental renal infarction, postoperative hypertension, or calyceal fistula formation. The problem with accessory renal artery is prolonged ischemia and delayed graft function. Long ischemia can be avoided if lower polar accessory renal artery is anastomosed to inferior epigastric artery after de-clamping as soon as the main renal artery and venous anastomosis is done. Aim: In this study we report our experience with live donor renal transplantation with multiple arteries in which the lower polar artery was anastomosed to the inferior epigastric artery. This study describes the surgical technique and outcomes of live donor renal allografts with multiple arteries in which the lower polar artery was anastomosed to the inferior epigastric artery after de-clamping. Material & Methods: Between 2012 and 2020, 68 consecutive live donor renal transplants were performed involving single Urology-Nephrology team. This included 48 with single and 20 with multiple arteries. Anastomosis of the lower polar artery to the inferior epigastric artery was used for 8 grafts with multiple arteries. Results: Successful revascularization of all areas of the transplanted graft was confirmed by Doppler ultrasonography in most patients and radionuclide renal scanning + MRA in some patients. Conclusions: In live donor renal transplantation with multiple arteries; the anastomosis of the lower polar artery to the inferior epigastric artery after de-clamping, avoids prolongation of the ischemia time that occur with other surgical techniques.

Published in	International Journal of Clinical Urology (Volume 7, Issue 1)
DOI	10.11648/j.ijcu.20230701.11
Page(s)	1-4
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Multiple Renal Artery Transplantation, Inferior Epigastric Artery, Renal Transplantation

References

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[2]	Pourmand G, Mehraban D, Ameli PJ, Ayati M, Naderi G. Donor polar kidney arteries: experience with 10 cases among 140 living-related kidney transplants. Transplant Proc. 1992 Oct; 24 (5): 1867. PMID: 1412888.
[3]	Guerra EE, Didoné EC, Zanotelli ML, Vitola SP, Cantisani GP, Goldani JC, Keitel E, Garcia VD. Renal transplants with multiple arteries. Transplant Proc. 1992 Oct; 24 (5): 1868. PMID: 1412889.
[4]	Belorusov OS, Goriaĭnov VA, Milanov NO. Peresadka pochki s mnozhestvennymi arteriiami ot zhivogo rodstvennogo donora [Transplantation of the kidney with numerous arteries from a living relative-donor]. Khirurgiia (Mosk). 1991 Jan; (1): 106-9.
[5]	Brannen GE, Bush WH, Correa RJ Jr, Gibbons RP, Cumes DM. Microvascular management of multiple renal arteries in transplantation. J Urol. 1982 Jul; 128 (1): 112-5. doi: 10.1016/s0022-5347(17)52778-0. PMID: 7050410.
[6]	Pollak R, Prusak BF, Mozes MF. Anatomic abnormalities of cadaver kidneys procured for purposes of transplantation. Am Surg. 1986 May; 52 (5): 233-5. PMID: 3518559.
[7]	Young JS, Rohr MS. Use of the inferior epigastric artery to revascularize a lower pole renal artery in renal transplant. Am Surg. 1995 Feb; 61 (2): 185-6. PMID: 7856984.
[8]	Wolters HH, Schult M, Heidenreich S, Chariat M, Senninger N, Dietl KH. The anastomosis between renal polar arteries and arteria epigastrica inferior in kidney transplantation: an option to decrease the risk of ureter necrosis? Transpl Int. 2001 Dec; 14 (6): 442-4. doi: 10.1007/s001470100011. PMID: 11793043.
[9]	Yamanaga S, Rosario A, Fernandez D, Kobayashi T, Tavakol M, Stock PG, et al. (2018) Inferior long-term graft survival after end-to-side reconstruction for two renal arteries in living donor renal transplantation. PLoS ONE 13 (7): e0199629. https://doi.org/10.1371/journal.pone.0199629
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[11]	Gomes LJ, Goldstein MJ, Hardy MA. The use of inferior epigastric artery in renal transplantation. Transplantation. 2009 Sep 15; 88 (5): 748-9. doi: 10.1097/TP.0b013e3181b3923f. PMID: 19741476.
[12]	Novick AC. Microvascular reconstruction of complex branch renal artery disease. Urol Clin North Am. 1984 Aug; 11 (3): 465-75. PMID: 6380079.
[13]	Aguiló J, Rodriguez O, Gaete J, Galleguillos I. Vascular anastomosis techniques in renal transplants. Int Angiol. 1991 Jan-Mar; 10 (1): 39-43. PMID: 2071973. Russian.
[14]	P. Ostrowski, M. J. Kotowski, K. Tejchman, M. Szemitko, J. Sieńko, M. Ostrowski, The Arterial Anastomosis Between Deep Inferior Epigastric Artery and Small Polar Renal Artery in Kidney Transplantation: A Case Report, Transplantation Proceedings, Volume 54, Issue 4, 2022, Pages 1145-1147.
[15]	Veeramani Muthu, Jain Vikas, Ganpule Arvind, Sabnis R B, Desai Mahesh R. Donor gonadal vein reconstruction for extension of the transected renal vessels in living renal transplantation. Indian Journal of Urology, 2010, Volume: 26, Issue 2, Pages: 314-316.
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APA Style

Kabilan Saminathan, Balaraman Velayutham, Muthu Veeramani. (2023). Inferior Epigastric Artery a Boon in Accessory Lower Polar Artery Revascularization in Renal Transplantation. International Journal of Clinical Urology, 7(1), 1-4. https://doi.org/10.11648/j.ijcu.20230701.11

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ACS Style

Kabilan Saminathan; Balaraman Velayutham; Muthu Veeramani. Inferior Epigastric Artery a Boon in Accessory Lower Polar Artery Revascularization in Renal Transplantation. Int. J. Clin. Urol. 2023, 7(1), 1-4. doi: 10.11648/j.ijcu.20230701.11

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AMA Style

Kabilan Saminathan, Balaraman Velayutham, Muthu Veeramani. Inferior Epigastric Artery a Boon in Accessory Lower Polar Artery Revascularization in Renal Transplantation. Int J Clin Urol. 2023;7(1):1-4. doi: 10.11648/j.ijcu.20230701.11

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@article{10.11648/j.ijcu.20230701.11,
  author = {Kabilan Saminathan and Balaraman Velayutham and Muthu Veeramani},
  title = {Inferior Epigastric Artery a Boon in Accessory Lower Polar Artery Revascularization in Renal Transplantation},
  journal = {International Journal of Clinical Urology},
  volume = {7},
  number = {1},
  pages = {1-4},
  doi = {10.11648/j.ijcu.20230701.11},
  url = {https://doi.org/10.11648/j.ijcu.20230701.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcu.20230701.11},
  abstract = {Multiple renal arteries occur unilaterally and bilaterally in 23% and 10% of the population, respectively. During renal transplantation failure to recognize and preserve an accessory renal artery may lead to ureteral necrosis, segmental renal infarction, postoperative hypertension, or calyceal fistula formation. The problem with accessory renal artery is prolonged ischemia and delayed graft function. Long ischemia can be avoided if lower polar accessory renal artery is anastomosed to inferior epigastric artery after de-clamping as soon as the main renal artery and venous anastomosis is done. Aim: In this study we report our experience with live donor renal transplantation with multiple arteries in which the lower polar artery was anastomosed to the inferior epigastric artery. This study describes the surgical technique and outcomes of live donor renal allografts with multiple arteries in which the lower polar artery was anastomosed to the inferior epigastric artery after de-clamping. Material & Methods: Between 2012 and 2020, 68 consecutive live donor renal transplants were performed involving single Urology-Nephrology team. This included 48 with single and 20 with multiple arteries. Anastomosis of the lower polar artery to the inferior epigastric artery was used for 8 grafts with multiple arteries. Results: Successful revascularization of all areas of the transplanted graft was confirmed by Doppler ultrasonography in most patients and radionuclide renal scanning + MRA in some patients. Conclusions: In live donor renal transplantation with multiple arteries; the anastomosis of the lower polar artery to the inferior epigastric artery after de-clamping, avoids prolongation of the ischemia time that occur with other surgical techniques.},
 year = {2023}
}

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TY  - JOUR
T1  - Inferior Epigastric Artery a Boon in Accessory Lower Polar Artery Revascularization in Renal Transplantation
AU  - Kabilan Saminathan
AU  - Balaraman Velayutham
AU  - Muthu Veeramani
Y1  - 2023/01/13
PY  - 2023
N1  - https://doi.org/10.11648/j.ijcu.20230701.11
DO  - 10.11648/j.ijcu.20230701.11
T2  - International Journal of Clinical Urology
JF  - International Journal of Clinical Urology
JO  - International Journal of Clinical Urology
SP  - 1
EP  - 4
PB  - Science Publishing Group
SN  - 2640-1355
UR  - https://doi.org/10.11648/j.ijcu.20230701.11
AB  - Multiple renal arteries occur unilaterally and bilaterally in 23% and 10% of the population, respectively. During renal transplantation failure to recognize and preserve an accessory renal artery may lead to ureteral necrosis, segmental renal infarction, postoperative hypertension, or calyceal fistula formation. The problem with accessory renal artery is prolonged ischemia and delayed graft function. Long ischemia can be avoided if lower polar accessory renal artery is anastomosed to inferior epigastric artery after de-clamping as soon as the main renal artery and venous anastomosis is done. Aim: In this study we report our experience with live donor renal transplantation with multiple arteries in which the lower polar artery was anastomosed to the inferior epigastric artery. This study describes the surgical technique and outcomes of live donor renal allografts with multiple arteries in which the lower polar artery was anastomosed to the inferior epigastric artery after de-clamping. Material & Methods: Between 2012 and 2020, 68 consecutive live donor renal transplants were performed involving single Urology-Nephrology team. This included 48 with single and 20 with multiple arteries. Anastomosis of the lower polar artery to the inferior epigastric artery was used for 8 grafts with multiple arteries. Results: Successful revascularization of all areas of the transplanted graft was confirmed by Doppler ultrasonography in most patients and radionuclide renal scanning + MRA in some patients. Conclusions: In live donor renal transplantation with multiple arteries; the anastomosis of the lower polar artery to the inferior epigastric artery after de-clamping, avoids prolongation of the ischemia time that occur with other surgical techniques.
VL  - 7
IS  - 1
ER  -

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Author Information

Kabilan Saminathan

Department of Urology, Dr Mehta’s Hospital, Chennai, India
Balaraman Velayutham

Department of Nephrology, Institute of Child Health, Dr MGR Medical University, Chennai, India
Muthu Veeramani

Department of Urology, SRM Institute of Medical Sciences, Chennai, India

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APA Style

Kabilan Saminathan, Balaraman Velayutham, Muthu Veeramani. (2023). Inferior Epigastric Artery a Boon in Accessory Lower Polar Artery Revascularization in Renal Transplantation. International Journal of Clinical Urology, 7(1), 1-4. https://doi.org/10.11648/j.ijcu.20230701.11

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ACS Style

Kabilan Saminathan; Balaraman Velayutham; Muthu Veeramani. Inferior Epigastric Artery a Boon in Accessory Lower Polar Artery Revascularization in Renal Transplantation. Int. J. Clin. Urol. 2023, 7(1), 1-4. doi: 10.11648/j.ijcu.20230701.11

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AMA Style

Kabilan Saminathan, Balaraman Velayutham, Muthu Veeramani. Inferior Epigastric Artery a Boon in Accessory Lower Polar Artery Revascularization in Renal Transplantation. Int J Clin Urol. 2023;7(1):1-4. doi: 10.11648/j.ijcu.20230701.11

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@article{10.11648/j.ijcu.20230701.11,
  author = {Kabilan Saminathan and Balaraman Velayutham and Muthu Veeramani},
  title = {Inferior Epigastric Artery a Boon in Accessory Lower Polar Artery Revascularization in Renal Transplantation},
  journal = {International Journal of Clinical Urology},
  volume = {7},
  number = {1},
  pages = {1-4},
  doi = {10.11648/j.ijcu.20230701.11},
  url = {https://doi.org/10.11648/j.ijcu.20230701.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcu.20230701.11},
  abstract = {Multiple renal arteries occur unilaterally and bilaterally in 23% and 10% of the population, respectively. During renal transplantation failure to recognize and preserve an accessory renal artery may lead to ureteral necrosis, segmental renal infarction, postoperative hypertension, or calyceal fistula formation. The problem with accessory renal artery is prolonged ischemia and delayed graft function. Long ischemia can be avoided if lower polar accessory renal artery is anastomosed to inferior epigastric artery after de-clamping as soon as the main renal artery and venous anastomosis is done. Aim: In this study we report our experience with live donor renal transplantation with multiple arteries in which the lower polar artery was anastomosed to the inferior epigastric artery. This study describes the surgical technique and outcomes of live donor renal allografts with multiple arteries in which the lower polar artery was anastomosed to the inferior epigastric artery after de-clamping. Material & Methods: Between 2012 and 2020, 68 consecutive live donor renal transplants were performed involving single Urology-Nephrology team. This included 48 with single and 20 with multiple arteries. Anastomosis of the lower polar artery to the inferior epigastric artery was used for 8 grafts with multiple arteries. Results: Successful revascularization of all areas of the transplanted graft was confirmed by Doppler ultrasonography in most patients and radionuclide renal scanning + MRA in some patients. Conclusions: In live donor renal transplantation with multiple arteries; the anastomosis of the lower polar artery to the inferior epigastric artery after de-clamping, avoids prolongation of the ischemia time that occur with other surgical techniques.},
 year = {2023}
}

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TY  - JOUR
T1  - Inferior Epigastric Artery a Boon in Accessory Lower Polar Artery Revascularization in Renal Transplantation
AU  - Kabilan Saminathan
AU  - Balaraman Velayutham
AU  - Muthu Veeramani
Y1  - 2023/01/13
PY  - 2023
N1  - https://doi.org/10.11648/j.ijcu.20230701.11
DO  - 10.11648/j.ijcu.20230701.11
T2  - International Journal of Clinical Urology
JF  - International Journal of Clinical Urology
JO  - International Journal of Clinical Urology
SP  - 1
EP  - 4
PB  - Science Publishing Group
SN  - 2640-1355
UR  - https://doi.org/10.11648/j.ijcu.20230701.11
AB  - Multiple renal arteries occur unilaterally and bilaterally in 23% and 10% of the population, respectively. During renal transplantation failure to recognize and preserve an accessory renal artery may lead to ureteral necrosis, segmental renal infarction, postoperative hypertension, or calyceal fistula formation. The problem with accessory renal artery is prolonged ischemia and delayed graft function. Long ischemia can be avoided if lower polar accessory renal artery is anastomosed to inferior epigastric artery after de-clamping as soon as the main renal artery and venous anastomosis is done. Aim: In this study we report our experience with live donor renal transplantation with multiple arteries in which the lower polar artery was anastomosed to the inferior epigastric artery. This study describes the surgical technique and outcomes of live donor renal allografts with multiple arteries in which the lower polar artery was anastomosed to the inferior epigastric artery after de-clamping. Material & Methods: Between 2012 and 2020, 68 consecutive live donor renal transplants were performed involving single Urology-Nephrology team. This included 48 with single and 20 with multiple arteries. Anastomosis of the lower polar artery to the inferior epigastric artery was used for 8 grafts with multiple arteries. Results: Successful revascularization of all areas of the transplanted graft was confirmed by Doppler ultrasonography in most patients and radionuclide renal scanning + MRA in some patients. Conclusions: In live donor renal transplantation with multiple arteries; the anastomosis of the lower polar artery to the inferior epigastric artery after de-clamping, avoids prolongation of the ischemia time that occur with other surgical techniques.
VL  - 7
IS  - 1
ER  -

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