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ORIGINAL ARTICLE
Year : 2017  |  Volume : 9  |  Issue : 2  |  Page : 166-169

Analysis of outcome of end-to-end and end-to-side internal iliac artery anastomosis in renal transplantation: Our initial experience with a case series


1 Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
2 Department of ardio Thoracic and Vascular Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India

Correspondence Address:
Dilip Kumar Pal
Department of Urology, Institute of Post Graduate Medical Education and Research, 244, AJC Bose Road, Kolkata - 700 020, West Bengal
India
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DOI: 10.4103/0974-7796.204176

PMID: 28479769

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Introduction: In renal transplantation, there is end-to-side anastomosis of renal artery to external iliac artery and end-to-end anastomosis of renal artery to internal iliac artery. The end-to-end internal iliac artery anastomosis can be associated with complications due to compromised distal vascular supply to limbs and penile erectile tissue. A method of end-to-side anastomosis can overcome them. Till date, there is no case series or trial that has studied the effect of end-to-side anastomosis. This study is aimed at comparing the outcome of end-to-side and end-to-end anastomosis, so as to evaluate the efficacy of end-to-side technique. Materials and Methods: A total of 40 renal transplant recipients were taken, with internal iliac artery anastomosis, and were divided into two groups, 20 patients with end-to-end and 20 patients with end-to-side anastomosis. The cold ischemia time, arterial anastomosis time, post-operative bleeding and urine leak, claudication, saddle anesthesia and erectile dysfunction, and follow-up recipient creatinine and eGFR and Doppler to look for graft renal artery patency (at 6 months post-transplant) were compared between the two groups. Results: The intraoperative cold ischemia time was slightly more in the group with end-to-end anastomosis, but it was statistically significant (P = 0.22). The arterial anastomosis time was comparable in both the groups (P = 0.65). In the end-to-end group, 15%, 20% and 15% patients had post-operative saddle anaesthesia, claudication and mild-to-moderate erectile dysfunction, which were absent in the end-to-side group. On follow-up, the mean recipient serum creatinine and eGFR were comparable in the two groups. Also, the graft renal artery patency on Doppler was comparable. Conclusion: The end-to-side technique can be definitely applied for renal transplantation, with some advantages over end-to-end technique, and without compromising efficacy.


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