Parachute Suture Technique with Arteriotomy by using Aortic Punch in Live Related Renal Transplant

Objective: To provide review of our experience in vascular anastomosis technique for kidney transplantation patients. Material and Methods: 100 chronic kidney disease patients 89 males and 11females with mean age 23.5 ± 3 years have been operated for kidney transplantation from January 2011 through April 2015. Vascular part of operation was done using parachute suture technique and arteriotomy by aortic punch. Recipients were prospectively entered into a database and retrospectively reviewed. Data collected included the warm and cold ischemic time, arterial and venous anastomotic time, color Doppler ultrasonography examination of the anastomosis site on 1, 7 postoperative days, mean serum creatinine level on 3, 14 days after the operation and any early or late postoperative complications. Results: Mean kidney warm and cold ischemia time was 7.5 ± 4minutes and 21.5 ± 7minutes respectively. Mean arterial and venous anastomotic time was 7.2 ± 9 minutes and 8 ± 4 minutes respectively. All allografts had single artery. Renal arteries were anastomosed to (53%) common iliac arteries, (40%) external iliac arteries, (6%) internal iliac arteries and just (1%) to lower aorta in recipients; however, allograft renal veins were anastomosed to (95%) common iliac vein and (5%) inferior vena cava recipients. No vascular complications were detected in the early postoperative period by Doppler ultrasonography examination. The mean serum creatinine level on the 3the and 14the days after the operation was 0.9 (range, 0.5-4 mg/dl) and 0.6(range 0.5-1.2 mg/dl) respectively. Slow graft function was diagnosed in 2patients, with a good perfusion of the allografts showed by renal scan. During a mean follow-up of 4 years, we did not encounter any case of renal artery or venous thrombosis or any suspected arterial stenosis. Conclusions: The parachute suture technique is safe and straightforward method for arterial and venous anastomosis in renal transplantation with low complication rates. Using aortic punch for arteriotomy facilitates the arterial anastomosis, which may results in excellent kidney function without stenosis of the renal artery.