Reconstruction of a Lower Polar Artery for Kidney Transplantation Using Donor Ovarian Vein: Case Report with Literature Review
Abstract
1. Introduction
2. Case Report
3. Discussion
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
ADPKD | Autosomal dominant polycystic kidney disease |
CT | Computed tomography |
DGF | Delayed graft function |
DGV | Donor gonadal vein |
eGFR | Glomerular filtration rate |
ESRD | End-stage renal disease |
GV | Gonadal vein |
IPA | Inferior polar artery |
LUHS | Lithuanian university of health sciences |
MPGN | Membranoproliferative glomerulonephritis |
NA | Not available |
PTFE | Polytetrafluoroethylene |
RA | Renal artery |
RV | Renal vein |
U | Ureter |
Appendix A
Adult |
Anastomosis, surgical/methods* |
Case reports |
Cold ischemia |
Computed tomography Angiography |
Female |
Follow-up studies |
Gonads/blood supply |
Graft survival |
Humans |
Kidney failure, chronic/surgery |
Kidney function Tests |
Kidney transplantation/methods* |
Lithuania |
Nephrectomy/complications |
Ovary/blood supply* |
Postoperative period |
Renal artery/injuries* |
Tissue donors |
Treatment outcome |
Vascular grafting/methods* |
Warm ischemia |
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Before Transplantation | 1 Month after Transplantation | 15 Months after Transplantation | |
---|---|---|---|
Creatinine (µmol/L) | ) | ||
Urea (mmol/L) | 7.9 | 7.1 | |
Potassium (mmol/L) | 4.53 | 4.06 | |
Urine pH | 8.0 | 7.5 | 6.5 |
Urine-specific gravity | 1012 | 1011 | 1006 |
Blood in urine | - | - | 0.3 |
Leukocytes in urine | - | ||
Erythrocytes in urine (microscopic urinalysis) | - | - | - |
Leukocytes in urine (microscopic urinalysis) | ) | - |
Vascular Reconstruction Techniques of Severed Polar Artery | Indication | Method | Advantages | Disadvantages |
---|---|---|---|---|
Ligation | Upper polar artery which supplies < 25% is severed | Ligation | Does not affect the function of the graft | Cannot be applied for the lower polar artery |
Direct repair | Distal end of the polar artery is preserved | Connection of two interrupted segments of the polar artery | Does not require additional vessels | Possible only if the aortic patch with polar artery bifurcation is retained |
End-to-side anastomosis | Distal end of the polar artery is severed | End-to-side anastomosis with the main renal artery, external iliac artery, or internal iliac artery | The diameters of vessels can be different | If back-table preparation is not used, warm ischemia time is prolonged Higher risk of stenosis and thrombosis |
End-to-end anastomosis | Distal end of the polar artery is severed | End-to-end anastomosis with hypogastric artery | Can be anastomosed after the main renal artery is reperfused Reduces ischemia time | The hypogastric artery is not always available due to atherosclerosis The size or diameter can be insufficient |
Side-to-side conjoined anastomosis | Two equal-sized arteries | Common ostium is made with another renal artery | Reduction in warm ischemia time due to single artery anastomosis | Arteries need to be comparable in size |
Vascular interposition graft | Insufficient artery length | Vascular interposition graft is made from donor or recipient’s vessel (saphenous vein, internal iliac artery, inferior epigastric artery, or gonadal vein) or PTFE; it is anastomosed to the severed polar artery and a larger vessel | No additional intraoperative or donor-site complications Decreases warm ischemia time due to back—table preparation | Saphenous vein graft has a higher risk of occlusion, aneurysms, and ruptures, and access to the vein requires an additional incision PTFE has the highest rate of thrombogenicity and infectability |
Authors | Year | Age | Sex | Diagnosis | Donor’s Kidney | Number of Allograft Renal Arteries | Source of Gonadal Vein | Interposition GraftAnastomosed to | Follow-Up Period |
---|---|---|---|---|---|---|---|---|---|
Chatzizacharias NA | 2010 | 28 | M | IgA nephropathy | Left | 2 | Donor | External iliac artery | NA |
Veeramani M | 2010 | 49 | M | ADPKD, ESRD | Left | 2 | Donor | External iliac artery | 2 years |
Uysal E | 2017 | 27 | M | ESRD | Right | 1 | Recipient | Internal iliac artery | 8 months |
Tomizawa M | 2020 | 34 | M | ESRD | Right | 3 | Donor | Graft made from the internal iliac artery | 3 years |
Present case | 2020 | 34 | F | Alport syndrome, MPGN, ESRD | Right | 2 | Donor | One of four renal arteries from a common trunk | 15 months |
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Bikauskaitė, S.; Počepavičiūtė, K.; Velička, L.; Jankauskas, A.; Trumbeckas, D.; Šuopytė, E. Reconstruction of a Lower Polar Artery for Kidney Transplantation Using Donor Ovarian Vein: Case Report with Literature Review. Medicina 2021, 57, 1248. https://doi.org/10.3390/medicina57111248
Bikauskaitė S, Počepavičiūtė K, Velička L, Jankauskas A, Trumbeckas D, Šuopytė E. Reconstruction of a Lower Polar Artery for Kidney Transplantation Using Donor Ovarian Vein: Case Report with Literature Review. Medicina. 2021; 57(11):1248. https://doi.org/10.3390/medicina57111248
Chicago/Turabian StyleBikauskaitė, Saulė, Kamilė Počepavičiūtė, Linas Velička, Antanas Jankauskas, Darius Trumbeckas, and Erika Šuopytė. 2021. "Reconstruction of a Lower Polar Artery for Kidney Transplantation Using Donor Ovarian Vein: Case Report with Literature Review" Medicina 57, no. 11: 1248. https://doi.org/10.3390/medicina57111248
APA StyleBikauskaitė, S., Počepavičiūtė, K., Velička, L., Jankauskas, A., Trumbeckas, D., & Šuopytė, E. (2021). Reconstruction of a Lower Polar Artery for Kidney Transplantation Using Donor Ovarian Vein: Case Report with Literature Review. Medicina, 57(11), 1248. https://doi.org/10.3390/medicina57111248