Ten Years of Experience with Vascular Complications in Renal Transplantation

Abstract

From 1970 to 1980, 341 consecutive renal transplants were performed in 307 patients at our hospital. Operative technique was uniform and performed by a single surgeon. Acute arterial thrombosis occurred in 12 kidneys (3.5 per cent) and venous thrombosis occurred in 3 (0.9 per cent). All of these kidneys were lost. Renal artery stenosis, diagnosed in 17 kidneys (4.9 per cent), resulted from surgical technique or rejection and was associated with hypertension in all cases. Of these kidneys 5 responded to drug therapy alone, 4 to transluminal angioplasty and 5 to surgical reconstruction. Three grafts were lost. Vascular complications occurred in 9 per cent of our patients. The results suggest that factors other than surgical technique alone can contribute to the incidence of vascular complications.

Complications of Renal Transplantation

“…35 Evaluation for renal artery patency should be performed in patients with severe hypertension refractory to medical therapy or with hypertension combined with either an audible bruit or unexplained graft dysfunction. Moderate hypertension alone is not a reliable marker for renal artery stenosis because up to 65% of transplant recipients have nonrenovascular hypertension.…”

“…Approximately half of renal artery stenoses occur at the anastomosis, and end-to-end anastomoses have a 3-fold greater risk of stenosis than end-to-side anastomoses. 35 …”

“…An increased prevalence of renal vein thrombosis in left lower quadrant allografts has also been attributed to compression of the left common iliac vein between the sacrum and the left common iliac artery (silent iliac artery compression syndrome). 35 On gray scale ultrasonography, renal vein thrombosis may manifest with an enlarged kidney. On Doppler ultrasonography, venous flow is reduced or absent, and there is increased resistance on the arterial side, often resulting in reversed diastolic flow (Figure 15).…”

Is Placing an Expansion Space at the Anastomosing Site of the Vessel for Prevention of Pursiness, Safe?

“…The vascular complications are two kinds: early and delayed, the early complication including stenosis and thrombosis. The early vascular complications are due to technical [2] which may be due to handling allograft vessel during procurement and irrigation (vessel trauma) and preparing recipient vessels (trauma) and anastomosing [3,4]. In kidney transplant anastomosing of the vessel may be carried out as end to end or end to side, end to side is less predisposes to stenosis [4].…”

“…The early vascular complications are due to technical [2] which may be due to handling allograft vessel during procurement and irrigation (vessel trauma) and preparing recipient vessels (trauma) and anastomosing [3,4]. In kidney transplant anastomosing of the vessel may be carried out as end to end or end to side, end to side is less predisposes to stenosis [4]. One of the most important problem with anastomosing is pursiness of anastomosing site which may predisposes to stagnation and thrombosis and stenosing.…”