As the artery lies medial to the vein, there are 2 problems
1 where to site the venous anastomosis, and
2 the arterial anastomosis
I cant find any references on the subject?
Sir
There is a suggestion in the textbook of Campbell-Walsh Urology. (figure 44-8)
Best wishes
It all depends on how the external iliac artery sits once you mobilise it from the retroperitoneum. I have found that that the artery can then be moved to sit more laterally and often away from the vein, so that the conventional vascular anastomoses can be performed. On occasion the external iliac vein sits lateral to the artery so in these particular cases the vascular anastomoses are performed taking into consideration the positioning of the allograft.
I think you mean the sagging artery which means downwards deviation of external iliac artery in the pelvic cavity before returning again to the femoral canal. It is occasionally seen during transplant. In this situation, you should examine the positioning of the graft with possibility of making the arterial anastomosis distal (or proximal) at the external iliac artery to avoid shortening of the renal artery if you put it opposite the sagging segment. The venous anastomosis is usually not a problem after that. If all these trials looked difficult you may change the plan for internal iliac artery end-to-end anastomosis.
Dissect the external and common iliac arteries and the take-off of the internal iliac artery. Completely mobilize the external and distal common iliac veins by looping a 0-silk tie around each of the posterior iliac vein branches to retract them so they can be pulled up out of the pelvis, ligated and divided. The tortuous external iliac artery will then lie medial to the iliac veins. Place the kidney transplant in the wound to determine the best fit and select a spot on the common or external iliac artery for the arterial anastomosis. Do the arterial anastomosis first. Use Rummel tourniquets on the external and common iliac veins, retract them anteriorly, and put the venous anastomosis where it naturally lies on the external iliac vein. (See Barry JM. Renal transplant technique in BJUI 2007.)
- Badges
- Science topic
- Similar topics
- Biological Science
- Anatomy