Diagnostic ultrasound ( PDFDrive )

CHAPTER 18 Organ Transplantation 643
A
B
C
FIG. 18.21 Hepatic Vein Stenosis. (A) Color Doppler and
(B) correlative CT show focal narrowing (arrow) of the right
hepatic vein at junction with IVC. (C) Spectral Doppler shows
monophasic low in the right hepatic vein.
and size of donor renal arteries. In patients with cadaveric
transplants, the donor artery, along with a portion of the aorta
(Carrel patch) are anastomosed end to side to the external iliac
artery. In patients with living donor transplants, the donor renal
artery is anastomosed to either the internal iliac artery (end to
end) or the external iliac artery (end to side) of the recipient.
Multiple donor arteries of similar size may be joined together
with a side-to-side anastomosis to form a common ostium.
Alternatively, multiple arteries may be anastomosed as a Carrel
patch, or anastomosed separately to the external iliac artery. 45,46
he donor renal vein is almost always anastomosed end to
side to the external iliac vein. In the case of multiple renal veins,
the smaller veins are usually ligated, resulting in a single donor
vein. 46
he ureter is usually anastomosed to the superolateral wall
of the urinary bladder through a neocystostomy. Several techniques
are used to create a neocystostomy, but the basic procedure
involves tunneling the ureter through the bladder wall to prevent
relux to the transplant. For patients undergoing repeat surgery
on the collecting system and those with complex surgeries, the
recipient’s ureter may be used as a conduit to the bladder 45
(Fig. 18.28).
Because of the chronic shortage of donor organs, paired
cadaveric kidneys from young (<5 years old) donors may be