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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