移植技術と研究

Is Placing an Expansion Space at the Anastomosing Site of the Vessel for Prevention of Pursiness, Safe?

Abstract

Afshar Zomorrodi, Farzad Kakei, Alireza Farshi and Sahar Zomorrodi

Kidney replacement is the best option for treatment of chronic renal failure patient. This treatment sometimes associates with some complications including: immunologic, vascular and urologic. The vascular complication is a dangerous complication which sometimes may result in losing allograft kidney. The vascular complications including: thrombosis and stricture. These complications can be induced by rejection or by technical fault. The technical fault including: the handling of the vessel and suturing of the vessel. One of the preventable faults is pursiness which may predispose the vessel to the stenosis. We studied the making expansion space between the vessel and first knotting of stitching for prevention of the pursiness of the vessel post anastomosis.

Material and methods: One hundred chronic kidney disease patients 51 males and 49 females with age between 15-67 have been operated for kidney transplant surgery at Imam Reza hospital (teaching hospital) since 2008 -2011. All of the patients have received allograft kidney from live unrelated donors. During surgery after preparation place for allograft kidney at retroperitoneal at fosse of iliac the internal iliac artery (hypogasteric artery) have been selected for renal artery anastomosis and external iliac vein have been selected for renal vein anastomosis. During vessel anastomosis between vessel and first knotting of stitching (continue suture with single thread) 5mm distance have been made as expansion space. After removing the clamp from the vessel bleeding has been controlled, post operation the kidney has been followed by color Doppler ultrasound.

Results: Post declamping the vessel, the expansion space was vanished and the hemeostasis was nearly complete without any significant bleeding and also without detecting any stenosis at anastomosing site with follow up with color Doppler ultrasound at least for 6 months post operation.

Conclusions: making expansion space between the first knot of stitching and the vessel at the anastomosing site for prevention of the pursiness of the vessel and stenosis is safe.