Microvascular reconstruction of complex branch renal artery disease

The task of renal revascularization is considerably more complicated in patients with branch disease because of the necessity to perform multiple vascular anastomoses to renal artery branches that may be difficult to expose and are small in caliber. Technical advances during the past decade, namely, incorporation of microvascular and extracorporeal techniques into the armamentarium of the renovascular surgeon, have improved this outlook. This article focuses on general microvascular principles and specific reconstructive techniques currently applicable to patients with branch renal artery disease.