A New Technique for Upper Polar Artery Revascularization Using the Inferior Epigastric Artery: A Case Series

Implantation of kidneys with multiple renal arteries increases rewarming time and is associated with higher delayed graft function and poorer outcomes. Polar arteries originating from the aorta are found in up to 10% of donors and are small in diameter (1.5-3 mm). Traditionally, lower polar arteries are revascularized with the inferior epigastric artery to avoid ureteric ischemia, and upper polar arteries are ligated based on the assumption that long-term graft function is not affected. The revascularization and reconstruction of these small polar arteries are difficult and increase ischemic times along with a significant risk of arterial complications. Separate implantation of upper polar arteries and the main renal artery to the external iliac artery is only possible with "clamps on" and would increase rewarming time. On the other hand, connecting an upper polar artery to the main renal artery or one of its branches could jeopardize the patency of the main artery. We describe a simple revascularization technique for upper polar arteries deemed >2 mm using the inferior epigastric artery, without increase in rewarming time.