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Chapter-45 Vascular Complications

BOOK TITLE: Kidney & Pancreas Transplantation

Author
1. Molmenti Ernesto P
ISBN
9789351523390
DOI
10.5005/jp/books/12547_46
Edition
1/e
Publishing Year
2015
Pages
6
Author Affiliations
1. Hofstra Northwell School of Medicine, Long Island, New York, USA, North Shore-LIJ Health System, Long Island, New York, USA; Hofstra North Shore–LIJ School of Medicine, Long Island, New York, USA
Chapter keywords
vascular complications, intraoperative Doppler evaluation, renal vessels, allograft malpositioning, anastomotic defects, anastomosis, intimal dissections, percutaneous pressure gradient measurements, percutaneous angioplasty

Abstract

An intraoperative Doppler evaluation of the transplant renal vessels as well as of the recipient vessels used for implantation both proximal and distal with respect to the anastomoses should be obtained to document satisfactory flow after the kidney has been placed in the position where it will lay after closure of the abdomen. If flow is not satisfactory, malpositioning of the allograft, anastomotic defects and pathologies in the recipient and donor native vessels should be considered. Other etiologies, such as back-walling of the anastomosis or intimal dissections, should always be considered in the differential diagnosis. Percutaneous pressure gradient measurements provide evidence of the severity of the stricture while percutaneous angioplasty can lead to temporary improvement.

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