Orthotopic ex vivo renal artery reconstruction

Ex vivo renal artery reconstruction is a technique used to repair renal vascular lesions not amenable to conventional in situ methods of revascularization, either because of anatomical considerations or the inability of the kidney to tolerate the extended period of warm ischemia necessary to complete the procedure. In general, this refers to lesions at or beyond the division of the main renal artery into the segmental branches. The kidney is mobilized to the level of the abdominal wall after dividing the origins of the renal artery and vein from the aorta and inferior vena cava, respectively. The ureter is left intact. The kidney is cooled by placing it in an external slush bath and by perfusion through the renal vessels of a cold electrolyte solution. A suitable conduit (usually saphenous vein or hypogastric artery) is then prepared for grafting. After completion of the distal anastomosis(es), the kidney is returned to the renal fossa, and the proximal anastomosis to the aorta is completed. The renal vein is then reattached, thus completing revascularization of the kidney. We report our experience with five orthotopic ex vivo renal artery reconstructions. Indications for the procedure, details of the technique, and expected results are discussed.