Conjoined arterial anastomosis; an aid in revascularizing donor kidneys with multiple renal arteries

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Many transplant centers have reported numerous techniques for the successful revascularization of donor kidneys that have multiple vessels. Several early reports from major centers have not included the technique of conjoining two vessels to form a common ostium.1–3 Conjoined anastomosis for joining multiple tubular structures into a single functioning unit has been helpful to vascular and urologic surgeons.4–7

At the Cleveland Clinic, when the Carrel patch cannot be used, the conjoined anastomosis has become the preferred technique for revascularizing donor kidneys with multiple vessels. The facility with which this anastomosis can be performed technically and its associated theoretically favorable flow characteristics5 have been the basis for this preference. This report focuses special attention on the unique advantages provided by conjoining two small vessels and also presents preliminary laboratory data which indicate that the theoretically favorable flow characteristics are in fact real.

Materials and methods

The technique for performing the conjoined vascular anastomosis has been described4 and is illustrated in Figure 1. With small vessels (1–2 ml) the initial side-to-side anastomosis should be done with interrupted 6-0 or 7-0 vascular silk rather than with the continuous suture shown in Figure 1. Unless both vessels are very small, optical magnification and microvascular instruments are not necessary.

Laboratory flow rates measured in excised canine arteries. The renal arteries and common iliac arteries in sacrificed mongrel dogs were dissected bilaterally, and suitable segments were excised. The renal arteries varied from 1.5 to 4.0 ml in diameter, and were divided into two. . .



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