title: Alternative grafting technique for patients unsuited to heterotopic transplantation due to diseased pelvic conditions.
abstract: BACKGROUND
  An alternative technique for kidney transplantation is presented for patients in whom the use of pelvic vessels is precluded.
  
  
  METHODS
  Of 482 cases of kidney or pancreas-kidney transplants, 4 were unsuited to heterotopic grafting, 1 due to multiple operations in the fossae and the 3 others due to extensive vascular occlusive disease. The patients were studied preoperatively by magnetic resonance angiography, which revealed extensive occlusive disease of the distal aorta and/or iliac vessels.
  
  
  RESULTS
  The patients received kidneys from living related donors as a third or second transplant opportunity in the orthotopic position (2 cases). Gross dissection of the aorta revealed a thickened wall, impeding direct anastomoses between the recipient's arteries and the donated organ. After a termino-lateral Dacron graft to the aorta, all cases were stented for uretero-uretero anastomosis. Recovery with respect to the renal graft was uneventful for all cases.
  
  
  CONCLUSIONS
  Alternative direct grafting from the aorta represents a viable and easy way to perform kidney transplants in patients unsuited to the heterotopic approach.
authors.affiliation: Section of Urology and Vascular Surgery, Hospital Beneficência Portuguesa, São Paulo, Brazil. paulortrodrigues@aol.com
authors.forename: Paulo
authors.initials: P
authors.lastname: Rodrigues
authors.forename: Márcio
authors.initials: M
authors.lastname: D'Império
authors.forename: Mariana
authors.initials: M
authors.lastname: Campagnari
authors.forename: Luís A R
authors.initials: LA
authors.lastname: Azevedo
authors.forename: João C
authors.initials: JC
authors.lastname: Campagnari
authors.forename: Bonno
authors.initials: B
authors.lastname: van Bellen
mesh_terms: D000328:Adult; D001012:Aorta, Abdominal / Q000601:surgery*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D012307:Risk Factors