Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania.
Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania.
Medicina (Kaunas). 2021 Nov 15;57(11):1248. doi: 10.3390/medicina57111248.
In the case of complicated kidney transplantation, when the accessory artery is severed, the main task is to decide whether to restore renal blood flow and which method should be used. In this report, we present a case of kidney transplantation with vascular reconstruction using an ovarian vein as an interposition graft between a larger branch of the main renal artery and the lower polar artery which was severed during kidney explantation. Kidney transplantation using an ovarian vein was performed for a 34-year-old woman with end-stage renal disease on 1 April 2020 in the Hospital of Lithuanian university of health sciences (LUHS) Kaunas Clinics. A lower accessory renal artery was severed during kidney explantation. As the ovarian vein of the donor remained and matched the diameter of the severed vessel, it was decided to use it as an insertion between the main renal artery and the accessory renal artery of the inferior pole. The cold ischemic time was 770 min and the warm ischemic time was 37 min. A month after transplantation, the patient's condition and daily urine output were normal and the serum creatinine level decreased rapidly. Fifteen months after the surgery, the function and structure of the transplant remained normal and there was no evidence of serious vascular complications on CT scans. This is the first case where graft function was verified after transplantation using three-dimensional CT angiography. If an inferior polar artery is severed, vascular reconstruction must be performed to preserve the function of the graft. Usually, the gonadal vein is available during donor nephrectomy; therefore, it can be explanted without additional difficulties or incisions. Although we have not reported any complications, further studies are recommended on the long-term outcomes of this alternative approach for the reconstruction of short renal arteries.
在复杂的肾移植中，如果副肾动脉被切断，主要任务是决定是否恢复肾血流以及应采用哪种方法。在本报告中，我们介绍了一例肾移植病例，在该病例中，使用卵巢静脉作为移植物，在主肾动脉的较大分支和在肾取出过程中被切断的下极动脉之间进行血管重建。2020 年 4 月 1 日，在立陶宛健康科学大学（LUHS）考纳斯临床医院，一名患有终末期肾病的 34 岁女性接受了使用卵巢静脉进行的肾移植。在肾取出过程中，一条下副肾动脉被切断。由于供体的卵巢静脉仍然存在并且与切断的血管直径相匹配，因此决定将其用作主肾动脉和下极副肾动脉之间的插入物。冷缺血时间为 770 分钟，热缺血时间为 37 分钟。移植后一个月，患者的病情和每日尿量正常，血清肌酐水平迅速下降。手术后 15 个月，移植肾的功能和结构保持正常，CT 扫描未见严重血管并发症的证据。这是首例使用三维 CT 血管造影术证实移植后移植物功能的病例。如果下极动脉被切断，必须进行血管重建以保留移植物的功能。通常，在供肾切除术中可获得性腺静脉；因此，可以在不增加额外困难或切口的情况下将其取出。尽管我们没有报告任何并发症，但建议对这种替代方法重建短肾动脉的长期结果进行进一步研究。
