Vascular Augmentation in Renal Transplantation: Supercharging and Turbocharging

Abstract

The most common anatomic variant seen in donor kidneys for renal transplantation is the presence of multiple renal arteries, which can cause an increased risk of complications. Accessory renal arteries should be anastomosed to the proper source arteries to improve renal perfusion via the appropriate vascular reconstruction techniques. In microsurgery, 2 kinds of vascular augmentation methods, known as 'supercharging' and 'turbocharging,' have been introduced to ensure vascular perfusion in the transferred flap. Supercharging uses a distant source of the vessels, while turbocharging uses vascular sources within the same flap territory. These technical concepts can also be applied in renal transplantation, and in this report, we describe 2 patients who underwent procedures using supercharging and turbocharging. In one case, the ipsilateral deep inferior epigastric artery was transposed to the accessory renal artery (supercharging), and in the other case, the accessory renal artery was anastomosed to the corresponding main renal artery with a vascular graft (turbocharging). The transplanted kidneys showed good perfusion and proper function. No cases of renal failure, hypertension, rejection, or urologic complications were observed. These microsurgical techniques can be safely utilized for renal transplantation with donor kidneys that have multiple arteries with a lower complication rate and better outcome.

Keywords: Reconstructive surgical procedures; Regional blood flow; Tissue and organ harvesting.

Fig. 1. Supercharging and turbocharging techniques of vascular augmentation

(A) Supercharging technique: the proximal end of the ipsilateral DIEA was used for end-to-end anastomosis to the small lower polar renal artery. (B) Turbocharging technique: an end-to-side anastomosis of the accessory renal artery to the main renal artery was performed with an ipsilateral DIEA graft. RA, renal artery; RV, renal vein; U, ureter; aRA, accessory renal artery; DIEA, deep inferior epigastric artery.

Fig. 2. Case 1, supercharging technique

(A) Isolation of the deep inferior epigastric artery. (B) Supercharging arterial augmentation by an anastomosis between the deep inferior epigastric artery and the accessory renal artery of the donor kidney. DIEA, deep inferior epigastric artery; Rt., right.

Fig. 3. Case 2, turbocharging technique

(A) Deep inferior epigastric artery graft. (B) Turbocharging arterial augmentation with an ipsilateral deep inferior epigastric artery graft. The accessory artery was found in the operative field and vascular augmentation was performed by anastomosis with a deep inferior epigastric artery graft. DIEA, deep inferior epigastric artery; Rt., right.