title: A novel technique for reconstruction of multiple renal arteries in live donor kidney transplantation: a case report and literature review.
abstract: BACKGROUND
  Reconstruction for three renal arteries from a living donor becomes a real challenge as the limited material can be used when compared with deceased donors. Therefore, in this report we introduce a novel technique by using the gonadal vein as a Carrel patch for reconstruction with three renal arteries. The other techniques will also be reviewed in this report.
  
  
  METHODS
  The living donor is a 51-year-old woman with three renal arteries on the left side and one renal artery on the right side, but with early branching 15 mm from the origin. The recipient is her husband, a 56-year-old with end-stage kidney disease secondary to type II diabetes. A left laparoscopic donor nephrectomy was performed successfully. The three renal arteries were anastomosed to the gonadal vein patch in a parallel fashion. Thereafter, the gonadal vein patch was anastomosed to the side of external iliac artery. The renal vein was anastomosed to the side of external iliac vein.
  
  
  RESULTS
  The kidney was reperfused rapidly and uniformly. The kidney functioned immediately. Doppler ultrasound and renal nuclear scans revealed that the perfusion of the kidney was normal. The creatinine level was 158 umol/L at day 7 and stable at 140 umol/L during the 2-month follow-up examination.
  
  
  CONCLUSIONS
  The gonadal vein can be used as a Carrel patch for multiple renal artery reconstruction, in particular, for more than two renal arteries. This technique provides a new approach for the reconstruction of multiple renal arteries in living donor kidney transplantations.
authors.affiliation: WA Liver and Kidney Transplant Service, Sir Charles Gairdner Hospital, Nedlands, Australia. bulang.he@health.wa.gov.au
authors.forename: B
authors.initials: B
authors.lastname: He
authors.forename: A
authors.initials: A
authors.lastname: Mitchell
mesh_terms: D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D010535:Laparoscopy; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D010053:Ovary / Q000098:blood supply*; D055420:Perfusion Imaging; D019651:Plastic Surgery Procedures; D012077:Renal Artery / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D012082:Renal Veins / Q000601:surgery; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color