Chiến lược xử trí các tình huống bất thường mạch máu trong phẫu thuật ghép thận: Kinh nghiệm từ 705 ca ghép thận tại Bệnh viện Trung ương Quân đội 108

Abstract

Objectives: To evaluate the spectrum of vascular abnormalities encountered during kidney transplantation, including both anatomical vascular variations and vascular abnormalities arising intraoperatively, and to analyze the management strategies employed at 108 Military Central Hospital. Subjects and Methods: A retrospective study was conducted on 705 kidney transplantations performed at 108 Military Central Hospital. Study variables included vascular abnormalities in both donors and recipients, encompassing pre-existing anatomical variations as well as intraoperative vascular abnormalities, the vascular reconstruction techniques used, and surgical outcomes. Results: Renal arterial abnormalities were identified in 21.3% of cases, predominantly double renal arteries (19.9%). Venous abnormalities were observed in 7.2% of cases, with short renal vein being the most common finding. Arterial management consisted of separate arterial anastomoses (49.3%) and arterial reconstruction (50.7%), with the pantaloon reconstruction technique being the most frequently used reconstructive approach. Venous abnormalities were primarily managed by renal vein extension using the donor gonadal vein (46%) or the recipient great saphenous vein (24%). Recipient vascular abnormalities occurred in 1.9% of cases, and all were successfully managed without graft abandonment. Conclusions: Vascular abnormalities are relatively common during kidney transplantation but can be effectively managed through individualized surgical strategies. Appropriate vascular reconstruction techniques ensure adequate graft perfusion without compromising transplant feasibility. Therefore, vascular abnormalities should no longer be considered a contraindication to modern kidney transplantation.