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1 . 2023

Use of CT perfusion to establish the best surgical strategy for vascular reconstruction in kidney transplants with accessory arteries

Abstract

In kidney recipients with atypical blood supply, surgical complications occur more frequently than in typical vascular architectonics (OR=2.76; 95% CI 1.21–2.55; p<0.05). Renal replacement therapy early for kidney allograft dysfunction (frequency of occurrence 34.6%) increases the risk of surgical complications in kidney transplant recipients with atypical blood supply (OR=1.64; 95% CI 0.49–5.3; p<0.05). Today there is no reliable rationale for the choice of surgical approach for reconstruction in case of accessory non-dominant arteries of a kidney transplant, and most standard imaging techniques does not allow to make a conclusion about hemodynamics after the reconstruction of the vessels.

Aim. To choose the best revascularization technique of nondominant accessory renal allograft arteries based on CT perfusion.

Material and methods. 54 kidney allograft recipients were evaluated in our study: 18 kidneys with end-to-side anastomosis of additional artery to the main renal artery, 18 kidneys with the separate anastomosis of the accessory renal artery with external iliac artery, 18 kidneys with single renal artery. 2 main parameters were estimated – arterial flow and blood volume.

Results. According to the statistical analysis data median values of arterial blood flow in the medulla were significantly higher in case of creation end-to-side accessory renal artery anastomosis. In case of separate anastomosis median values of arterial flow in cortex was significantly lower than median values of arterial flow in the control group of grafts supplied from the main renal artery.

Conclusion. Еnd-to-side anastomosis technique provides better blood supply in medulla in comparison with separate anastomosis of additional artery. Creation of end-to-side anastomosis of accessory renal artery provides arterial blood flow that does not significantly differ from blood supply in kidneys with ordinary vascularization.

Keywords:kidney transplantation; additional renal artery; CT perfusion; arterial flow; blood volume

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Liovina D.I., Kocheshkova A.A., Nosik A.V., Kalachik O.V. Use of CT perfusion to establish the best surgical strategy for vascular reconstruction in kidney transplants with accessory arteries. Clinical and Experimental Surgery. Petrovsky Journal. 2023; 11 (1): 18–26. DOI: https://doi.org/10.33029/2308-1198-2023-11-1-18-26  (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

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