Multiple Arterial Vessels Research Articles

Laparoscopic Living Donor Nephrectomy for Kidneys With Multiple Arteries

Introduction Laparoscopic donor nephrectomy (LDN) involving kidneys with multiple arterial vessels is limited to a small number of reports, with all but two series reporting fewer than 25 patients. Moreover, outside of the pioneering centers at the University of Maryland and Johns Hopkins, no series of at least 25 patients has been published confirming these experience. The present study presents the largest series of LDN of donor kidneys with multiple arterial vessels outside of these two pioneering programs. Methods All LDN performed at the University of Cincinnati from 2000 to 2004 were reviewed. Results between LDN kidneys with a single vessel and those with multiple vessels were compared. Statistical analysis included chi-square and Student t test. Results Of 240 LDN, 37 were performed for kidneys with multiple vessels (15%): nine right kidneys (25%) and 28 left kidneys (75%). Cold ischemia time was longer for the multiple vessel organs (46 ± 24 minutes) than for single vessel organs (35 ± 13 minutes; P = .001), and warm ischemia time was longer for the multiple vessel kidneys (4:20 ± 2:05 minutes) than single vessel kidneys (3:13 ± 0:47 minutes; P = .001). Recipient renal function (serum creatinine) was similar for multiple and single artery donors at postoperative day 7 (1.76 ± 1.38 and 1.7 ± 1.47) and at postoperative day 365 (1.06 ± 0.3 and 1.34 ± 0.44). Conclusions This experience confirms results from other series in documenting the safety and reproducibility of LDN for kidneys with multiple arterial vessels.

Angioarchitecture and blood supply of micro- and macrometastases in human livers: An anatomic-pathological investigation using injection-techniques

The histological and stereoscopical appearance of the metastatic vascular tree was examined in a series of 23 human metastatic livers using injection techniques. All metastases showed an abnormal 'construction-concept' of vascularization, never imitating the normal angioarchitecture of the liver parenchyma. 17 of 22 arterial injected livers contained hyper-, and 5 hypovascularized metastases. Two main types of hypervascularized metastases could be detected: a central type with blood supply via a main arterial 'hilus-like' branch, and a peripheral type with multiple arterial vessels infiltrating from the metastatic surrounding. Of 13 livers injected via the portal vein, 11 showed a portal supply of the metastases. Portal tumor thrombi were a frequent finding, possibly indicating a retrograde portal local tumor spread within the liver. No larger branches of the hepatic vein could be found in any metastases which were injected via the hepatic veins; all showed typical signs of compression, displacement and destruction. Micrometastases were found in the direct surroundings of almost half of all macrometastases. Up to a size of 100-200 microns they appeared to be mainly supplied by sinusoidal blood. With continuing growth, newly built capillaries could be shown in the direct surroundings of some of the micrometastases.