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

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.