Analysis of outcome of end-to-end and end-to-side internal iliac artery anastomosis in renal transplantation: Our initial experience with a case series

Abstract

Introduction:In renal transplantation, there is end-to-side anastomosis of renal artery to external iliac artery and end-to-end anastomosis of renal artery to internal iliac artery. The end-to-end internal iliac artery anastomosis can be associated with complications due to compromised distal vascular supply to limbs and penile erectile tissue. A method of end-to-side anastomosis can overcome them. Till date, there is no case series or trial that has studied the effect of end-to-side anastomosis. This study is aimed at comparing the outcome of end-to-side and end-to-end anastomosis, so as to evaluate the efficacy of end-to-side technique.Materials and Methods:A total of 40 renal transplant recipients were taken, with internal iliac artery anastomosis, and were divided into two groups, 20 patients with end-to-end and 20 patients with end-to-side anastomosis. The cold ischemia time, arterial anastomosis time, post-operative bleeding and urine leak, claudication, saddle anesthesia and erectile dysfunction, and follow-up recipient creatinine and eGFR and Doppler to look for graft renal artery patency (at 6 months post-transplant) were compared between the two groups.Results:The intraoperative cold ischemia time was slightly more in the group with end-to-end anastomosis, but it was statistically significant (P = 0.22). The arterial anastomosis time was comparable in both the groups (P = 0.65). In the end-to-end group, 15%, 20% and 15% patients had post-operative saddle anaesthesia, claudication and mild-to-moderate erectile dysfunction, which were absent in the end-to-side group. On follow-up, the mean recipient serum creatinine and eGFR were comparable in the two groups. Also, the graft renal artery patency on Doppler was comparable.Conclusion:The end-to-side technique can be definitely applied for renal transplantation, with some advantages over end-to-end technique, and without compromising efficacy.

Calcium Score of Iliac Vessels and Relative Sparing of the External Iliac Artery Could Recommend Surgical Arterial Graft Selection

“…At our institution, most of the renal transplantations are performed by end-to-end anastomosis to the internal iliac artery (IIA). Previously, some studies favored EIA endto-side anastomosis over other arteries in renal transplantation (14). This finding could be attributed to larger caliber, existence of accessory renal arteries, and lower risk of compromising distal vascular supply to the pelvis (14,15).…”

“…Previously, some studies favored EIA endto-side anastomosis over other arteries in renal transplantation (14). This finding could be attributed to larger caliber, existence of accessory renal arteries, and lower risk of compromising distal vascular supply to the pelvis (14,15). However, Matheus et al called this finding into question by showing no differences in clinical or surgical complications for arterial anastomosis between end-to-side anastomosis to the EIA and end-to-end anastomosis to the IIA (16).…”

Imaging of Renal Transplant Complications throughout the Life of the Allograft: Comprehensive Multimodality Review

“…In the case of a living kidney donor, end-toside anastomosis of the donor renal artery and recipient EIA is usually performed. End-to-end anastomosis with the recipient internal iliac artery is usually reserved for cases where the EIA has already been used for a prior transplant or where atherosclerotic disease of the EIA warrants an alternate anastomosis site (22,23,26). The donor renal vein is usually anastomosed to the recipient external iliac vein in an end-to-side fashion (22).…”

Sequential analysis of single-center experience of living donor kidney transplants with several vascular anastomosis techniques

“…The anastomoses were performed using the external, internal, and common iliac arteries, although they were not distributed homogeneously [8,9]. An end-to-side anastomosis was preferred for the external iliac artery, whereas both end-toend and end-to-side anastomoses were performed on the internal iliac artery [10,11]. An end-to-end anastomosis to the internal iliac artery is preferred if the renal artery is too short or the anastomosis to the external iliac artery will be stretched or if the external iliac artery is atherosclerotic.…”