title: Anastomosis of accessory arteries via microsurgical technique in renal transplantation.
abstract: OBJECTIVE
  For many years there has been reluctance to use kidneys having multiple arteries of <2 mm diameter, especially where they supply the lower pole. The usage of these kidneys has increased using microsurgical anastomosis techniques. We reviewed the anastomotic techniques among renal transplantations with multiple arteries.
  
  
  METHODS
  Between January 2008 and August 2010, we examined the perfusion of 605 live donor kidneys bearing multiple arteries at 1 week and after 3 months using Doppler ultrasonography and magnetic resonance imaging (MRI) angiography. In addition, we reviewed vascular and urinary complications. The diameters of the arteries were measured using multi-slice computerized tomographic (CT) angiography.
  
  
  RESULTS
  Multiple arteries were detected in 49 (8.1%) kidneys, including 14 from the right and 35 left: namely, 45 with double and 4 with 3 arteries. In 26 patients an end-to-side microsurgical anastomosis was performed using the accessory artery; 23 organs underwent other techniques. The average diameter of all arteries was 3.89 ± 1.38 mm (thinnest, 1.2; widest, 8 mm). The average diameter of the main arteries was 5.12 ± 1.16 mm (thinnest, 3; widest, 8 mm) and the accessory arteries 2.81 ± 0.69 mm (thinnest, 1.2; widest, 3.8 mm). In patients with microsurgical techniques the average diameters of all arteries and accessory arteries were 3.7 ± 1.6 mm and 2.6 ± 0.69 mm, respectively. In those undergoing techniques other than microsurgery, the average diameters of all arteries and accessory arteries were 4.11 ± 1.34 mm and 3.1 ± 0.43 mm, respectively. The average diameters of the arteries in both groups were significantly different (P < .001). Kidney perfusion was intact upon ultrasonographic and MRI angiography of all patients. In 1 subject with a microsurgical technique used, anastomostic dehiscence with bleeding was observed after removal of the arterial clamps. Also in this group, 1 patient experienced a ureteral stricture beyond postoperative month one.
  
  
  CONCLUSIONS
  Microsurgery is a reliable technique for kidneys with thin accessory renal arteries.
authors.affiliation: Gaziosmanpasa Hospital, Istanbul, Turkey.
authors.forename: B
authors.initials: B
authors.lastname: Mersa
authors.forename: A
authors.initials: A
authors.lastname: Gürkan
authors.forename: B
authors.initials: B
authors.lastname: Ozçelik
authors.forename: S
authors.initials: S
authors.lastname: Kaçar
authors.forename: C
authors.initials: C
authors.lastname: Varılsüha
authors.forename: V
authors.initials: V
authors.lastname: Turunç
authors.forename: S
authors.initials: S
authors.lastname: Baş
authors.forename: S
authors.initials: S
authors.lastname: Server
mesh_terms: D000714:Anastomosis, Surgical; D001158:Arteries / Q000601:surgery*; D006801:Humans; D016030:Kidney Transplantation; D008279:Magnetic Resonance Imaging; D008866:Microsurgery / Q000379:methods*; D018608:Ultrasonography, Doppler