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Manjatika AT, Mazengenya P, Davimes JG. Bilateral duplicated inferior vena cava associated with aberrant internal iliac and gonadal veins: A case-based narrative review. Ann Anat 2024; 253:152223. [PMID: 38295909 DOI: 10.1016/j.aanat.2024.152223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/09/2023] [Accepted: 01/25/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND The left side anterior retroperitoneal approach is preferred for the management of lumbosacral spine disorders as there is reduced risk for vascular injury. The presence of multiple and uncommon venous variations on either side of the spine, like the bilateral duplicated inferior vena cava (DIVC), may complicate surgery in this region. The current study describes two rare cases of bilateral duplicated inferior vena cava associated with internal iliac and gonadal veins. METHODS The cases were identified during routine human dissections of the posterior abdominal wall of 89 (45 males, 44 females) individuals. The course, relations and morphometry of each duplicated inferior vena cava were examined and recorded. RESULTS Two (2.2%) of the 89 (1 male, 1 female) dissected individuals showed the presence of bilateral duplicated infrarenal segments of the inferior vena cava. In both cases, the pre-aortic trunk (vein) was the largest and the left inferior vena cava was the smallest. Both cases of bilateral DIVC presented with anomalous interiliac communicating veins, internal iliac veins, and drainage sites of the left gonadal veins. CONCLUSIONS The duplicated inferior vena cava may present with associated venous anomalies like those related to the gonadal and internal iliac veins. Knowledge of the duplicated inferior vena cava and its associated venous anomalies may be essential for accurately identifying and diagnosing vascular dysfunction and improving radiological interpretation across multiple surgical specialities.
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Affiliation(s)
- Arthur Tsalani Manjatika
- School of Anatomical Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa; School of Life Sciences, Anatomy Division, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Pedzisai Mazengenya
- College of Medicine, Ajman University, Ajman, United Arab Emirates; Center of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates; Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa.
| | - Joshua Gabriel Davimes
- School of Anatomical Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
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Ranade AV, Rai R, Rai AR, Joy T, Janardhanan JP, Dass PM. Drainage Pattern of Craniofacial Veins With Emphasis on its Influence on Facial Reconstruction Procedures. J Craniofac Surg 2024; 35:243-246. [PMID: 37646347 DOI: 10.1097/scs.0000000000009720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/09/2023] [Indexed: 09/01/2023] Open
Abstract
As the facial transplantation procedures are becoming more popular and frequent in recent years, for repairing facial trauma, variations in the veins of head and neck needs to be reported time and again. This study was undertaken to examine the course and drainage pattern of the facial vein and external jugular vein on this context and emphasize its surgical implications. The authors studied the head and neck region of 50 embalmed cadavers of both sexes to document normal and variant anatomy of facial, retromandibular, and external jugular veins. In 30% of the head and neck regions, different draining pattern of the above-mentioned veins were observed. One of the rare variation discovered was the splitting of the retromandibular vein to embrace the external carotid artery within the parotid gland. The data about variations in the termination of facial vein, retromandibular vein, and external jugular vein, as observed in the present study might be useful in avoiding accidental injury to these vessels during any surgical intervention in the face as well as neck. Level of Evidence: IV.
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Affiliation(s)
- Anu V Ranade
- Department of Basic Sciences, College of Medicine, University of Sharjah, Sharjah, UAE
| | - Rajalakshmi Rai
- Department of Anatomy, Center for Basic Sciences, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ashwin R Rai
- Department of Anatomy, Center for Basic Sciences, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Teresa Joy
- Department of Anatomy, College of Medicine, American University of Antigua, Coolidge, Antigua
| | - Jiji P Janardhanan
- Department of Anatomy, Center for Basic Sciences, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Prameela M Dass
- Department of Anatomy, Center for Basic Sciences, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Orellana-Donoso M, Milos-Brandenberg D, Benavente-Urtubia A, Guerra-Loyola J, Bruna-Mejias A, Nova-Baeza P, Becerra-Farfán Á, Sepulveda-Loyola W, Luque-Bernal RM, Valenzuela-Fuenzalida JJ. Incidence and Clinical Implications of Anatomical Variations in the Pancreas and Its Ductal System: A Systematic Review and Meta-Analysis. Life (Basel) 2023; 13:1710. [PMID: 37629567 PMCID: PMC10455790 DOI: 10.3390/life13081710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE This systematic review analyzes the anatomical variants in the pancreas and its ductal system to report on their association with pancreatic pathologies. METHODS We conducted a search of the MEDLINE, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception to July 2023. The methodological quality was assessed with the Anatomical Quality Assessment (AQUA) tool. Finally, the pooled prevalence was estimated using a random effects model. RESULTS 55 studies were found that met the eligibility criteria. The overall prevalence of pancreas divisum (PD) was 18% (95% CI = 15-21%). The prevalence of PD associated with pancreatitis was 30% (95% CI = 1-61%). CONCLUSIONS An anatomical variant of the pancreas such as PD may be the cause of bile duct obstruction, resulting in various clinical complications, such as pancreatitis. Hence, knowing this variant is extremely important for surgeons, especially for those who treat the gastroduodenal region.
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Affiliation(s)
- Mathias Orellana-Donoso
- Escuela de Medicina, Universidad Finis Terrae, Santiago 7500000, Chile;
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (A.B.-U.); (J.G.-L.); (A.B.-M.); (P.N.-B.)
| | - Daniel Milos-Brandenberg
- Escuela de Medicina, Facultad Ciencias de la Salud, Universidad del Alba, Santiago 8320000, Chile;
| | - Andoni Benavente-Urtubia
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (A.B.-U.); (J.G.-L.); (A.B.-M.); (P.N.-B.)
| | - Javier Guerra-Loyola
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (A.B.-U.); (J.G.-L.); (A.B.-M.); (P.N.-B.)
| | - Alejandro Bruna-Mejias
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (A.B.-U.); (J.G.-L.); (A.B.-M.); (P.N.-B.)
| | - Pablo Nova-Baeza
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (A.B.-U.); (J.G.-L.); (A.B.-M.); (P.N.-B.)
| | - Álvaro Becerra-Farfán
- Departamento de Ciencias Química y Biológicas, Facultad de Ciencias de la Salud, Universidad Bernardo O’Higgins, Santiago 8370993, Chile;
| | - Walter Sepulveda-Loyola
- Faculty of Health and Social Sciences, Universidad de las Américas, Santiago 8370040, Chile;
| | - Ricardo Miguel Luque-Bernal
- Unidad de Anatomía, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá 111221, Colombia;
| | - Juan José Valenzuela-Fuenzalida
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (A.B.-U.); (J.G.-L.); (A.B.-M.); (P.N.-B.)
- Department of Morphology and Function, Faculty of Health and Social Sciences, Universidad de Las Américas, Santiago 8370040, Chile
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Agrawal D, Saigal S. Early allograft dysfunction after living donor liver transplantation-current concepts and future directions. Liver Transpl 2023; 29:871-884. [PMID: 37162155 DOI: 10.1097/lvt.0000000000000173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/03/2023] [Indexed: 05/11/2023]
Abstract
Early allograft dysfunction (EAD) after liver transplantation is a significant clinical problem that negatively impacts graft and patient outcomes. The rising incidence of EAD and what it means concerning living donor liver transplantation (LDLT) is an area of great interest. However, EAD after LDLT is a complex research topic yet to be reviewed comprehensively. Most of the literature on EAD is based on experience in deceased donor liver transplantation, and limited information is available in the context of LDLT. Thus, in this review, we present an overview of EAD after LDLT and have attempted to present balanced points of view on all its aspects, such as definitions, pathogenesis, risk factors, predictive markers, and management. The review aims to broadly overview the nature and extent of ongoing research evidence on this complex topic and inform practice in the field by identifying key concepts and knowledge gaps and highlighting areas that require further inquiry.
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Affiliation(s)
- Dhiraj Agrawal
- Department of Gastroenterology and Hepatology, PACE Hospitals, Hitec City, Hyderabad, India
| | - Sanjiv Saigal
- Hepatology and Liver Transplant, Centre for Liver & Biliary Sciences, Centre of Gastroenterology, Hepatology & Endoscopy, Max Super Speciality Hospital, Saket, New Delhi, India
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Cullinane DP, Barry DS. Breaking the norm: Anatomical variation and its key role in medical education. ANATOMICAL SCIENCES EDUCATION 2022; 15:803-805. [PMID: 34657381 DOI: 10.1002/ase.2141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/13/2021] [Accepted: 10/14/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Dearbhla P Cullinane
- Department of Anatomy, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, The University of Dublin, Dublin 2, Republic of Ireland
| | - Denis S Barry
- Department of Anatomy, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, The University of Dublin, Dublin 2, Republic of Ireland
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Paired Exchange Living Donor Liver Transplantation: A Nine-year Experience From North India. Transplantation 2022; 106:2193-2199. [PMID: 35777310 DOI: 10.1097/tp.0000000000004210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Paired exchange liver transplantation is an evolving strategy to overcome ABO blood group incompatibility and other barriers such as inadequate graft-to-recipient weight ratio and low remnant liver volume in donors. However, for the transplant team to carry 4 major operations simultaneously is a Herculean effort. We analyzed our experience with liver paired exchange (LPE) program over the past 9 y. METHODS This prospective study included 34 of 2340 (1.45%) living donor liver transplantations performed between May 2012 and April 2021. The reason for LPE was ABO incompatibility in all (n = 34) patients included in the study. After donor reassignment through 2-by-2 paired exchange with directed donors, the ABO matching status changed from A to A (n = 17) and B to B (n = 17), which made all matches ABO-identical. Recipients (R) and donors (D) of each swap pair were prospectively divided into R1/D1 and R2/D2 groups for comparative and survival analyses. RESULTS The recipients (n = 34) had a median age of 45.5 y (11-59 y), and 31 were men. LPEs were performed in 4 operating rooms running simultaneously by 2 independent surgical teams. Donor survival was 100%. Baseline clinical and perioperative parameters, postoperative complications, median intensive care unit/hospital stay, and early deaths were comparable (P > 0.1) between the R1 and R2 groups. The median follow-up period was 27 mo (1-108 mo). The 30-d and 1-y survivals were 88.2% (n = 30) and 85.3% (n = 29), respectively. CONCLUSIONS Our experience suggests that with careful attention to ethical and logistical issues, the LPE program can expand the living donor liver pool and facilitate a greater number of living donor liver transplantations.
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Nerli R, Chandra S, Ghagane S, Dixit N, Muzumdar A, Donkar P. Transplantation in a recipient with crossed renal ectopia and donor with early branching of the left renal artery - A case report. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_43_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Ghazaly M, Sethi P, Kathirvel M, Tiwari NA, Thillai M, Gaurav R, Surendrakumar V, Ayorinde JOO, Allison M, Upponi S, Watson CJ, Praseedom RK, Gibbs P, Saeb-Parsy K. OUP accepted manuscript. BJS Open 2022; 6:6526445. [PMID: 35143624 PMCID: PMC8830758 DOI: 10.1093/bjsopen/zrab146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mohamed Ghazaly
- Transplant Unit, Addenbrooke’s Hospital, Cambridge, UK
- Department of Surgery, Tanta University, Tanta, Gharbia, Egypt
| | - Pulkit Sethi
- Transplant Unit, Addenbrooke’s Hospital, Cambridge, UK
| | | | | | - Manoj Thillai
- Transplant Unit, Addenbrooke’s Hospital, Cambridge, UK
| | - Rohit Gaurav
- Transplant Unit, Addenbrooke’s Hospital, Cambridge, UK
| | | | | | - Michael Allison
- Department of Hepatology, Cambridge Biomedical Research Centre, Addenbrooke’s Hospital, Cambridge, UK
| | - Sara Upponi
- Department of Radiology, Addenbrooke’s Hospital, Cambridge, UK
| | - Christopher J. Watson
- Transplant Unit, Addenbrooke’s Hospital, Cambridge, UK
- Department of Surgery, University of Cambridge, and Cambridge NIHR Biomedical Centre, Cambridge, UK
| | | | - Paul Gibbs
- Transplant Unit, Addenbrooke’s Hospital, Cambridge, UK
| | - Kourosh Saeb-Parsy
- Transplant Unit, Addenbrooke’s Hospital, Cambridge, UK
- Department of Surgery, University of Cambridge, and Cambridge NIHR Biomedical Centre, Cambridge, UK
- Correspondence to: Kourosh Saeb-Parsy, Department of Surgery, Addenbrooke’s Hospital, Hills Road, Box 202, Cambridge CB2 0QQ, UK (e-mail: )
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Serrablo A, Serrablo L, Alikhanov R, Tejedor L. Vascular Resection in Perihilar Cholangiocarcinoma. Cancers (Basel) 2021; 13:5278. [PMID: 34771439 PMCID: PMC8582407 DOI: 10.3390/cancers13215278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 12/16/2022] Open
Abstract
Among the cholangiocarcinomas, the most common type is perihilar (phCC), accounting for approximately 60% of cases, after which are the distal and then intrahepatic forms. There is no staging system that allows for a comparison of all series and extraction of conclusions that increase the long-term survival rate of this dismal disease. The extension of the resection, which theoretically depends on the type of phCC, is not a closed subject. As surgery is the only known way to achieve a cure, many aggressive approaches have been adopted. Despite extended liver resections and even vascular resections, margins are positive in around one third of patients. In the past two decades, with advances in diagnostic and surgical techniques, surgical outcomes and survival rates have gradually improved, although variability is the rule, with morbidity and mortality rates ranging from 14% to 76% and from 0% to 19%, respectively. Extended hepatectomies and portal vein resection, or even right hepatic artery reconstruction for the left side tumors are frequently needed. Salvage procedures when arterial reconstruction is not feasible, as well as hepatopancreatoduodenectomy, are still under evaluation too. In this article, we discuss the aggressive surgical approach to phCC focused on vascular resection. Disparate results on the surgical treatment of phCC made it impossible to reach clear-cut conclusions.
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Affiliation(s)
- Alejandro Serrablo
- Section of Surgery, European Union of Medical Specialists, 1040 Brussels, Belgium
- HPB Surgical Division, Miguel Servet University Hospital, Zaragoza University, 50009 Zaragoza, Spain
| | - Leyre Serrablo
- Medicine School, Zaragoza University, 50009 Zaragoza, Spain;
| | - Ruslan Alikhanov
- Division of Liver and Pancreatic Surgery, Moscow Clinical Research Center, 111123 Moscow, Russia;
| | - Luis Tejedor
- Department of Surgery, Punta Europa Hospital, 11207 Algeciras, Spain;
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Nigro B, Ayarragaray JEF. Anomalies of Inferior Vena Cava: Implications and Considerations in Retroperitoneal Surgical Procedures. Ann Vasc Surg 2021; 79:372-379. [PMID: 34644626 DOI: 10.1016/j.avsg.2021.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/24/2021] [Accepted: 07/04/2021] [Indexed: 11/01/2022]
Abstract
Anomalies of the inferior vena cava pose a great challenge to surgeons. Although uncommon, these congenital vascular malformations may have significant surgical implications. Awareness of their presence is essential to avoid inadvertent injury and major bleeding during retroperitoneal procedures. An accurate preoperative diagnosis and detailed planning play a crucial role to obtain successful outcomes when confronted with them. Several surgical techniques have been recommended to protect these anomalous venous structures. The aim of this review is to contribute to the knowledge of the most common types of anomalies of inferior vena cava encountered during retroperitoneal procedures. With this purpose, a summary of their anatomy, embryology, incidence, diagnosis and intra-operative management is presented.
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Affiliation(s)
- Belén Nigro
- Department of Cardiovascular Surgery, Sanatorio de La Trinidad Mitre, Capital Federal, Argentina.
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Abbey E, Yang F, Qi L, Wu JJ, Tong L, Zhen Z. Situs inversus totalis patients with gastric cancer: Robotic surgery the standard of treatment?-A case report. Int J Surg Case Rep 2021; 81:105818. [PMID: 33887833 PMCID: PMC8050025 DOI: 10.1016/j.ijscr.2021.105818] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/21/2021] [Accepted: 03/21/2021] [Indexed: 12/27/2022] Open
Abstract
Situs inversus totalis is a very rare congenital anomaly. Variant anatomy will inevitably conflict with surgical habits. Minimally invasive surgery for situs inversus totalis patients has more advantages over traditional surgery.
Introduction and importance Situs inversus totalis (SIT) is a very rare congenital condition. Situs inversus totalis (SIT) patients who present with gastric cancer have been reported in Japan, China, the United States, and other countries. China has a high incidence of gastric cancer, accounting for 40% of the global annual incidence. Surgical treatment options for situs inversus totalis (SIT) gastric cancer patients are of great concern due to the rare nature of the condition and the anatomical variations. This case aims to demonstrate the utility of robotic surgery in treating situs inversus totalis patients with gastric cancer. Case presentation We report a 69-year-old male situs inversus totalis (SIT) gastric cancer patient who successfully underwent a DaVinci robotic-assisted distal gastrectomy with Roux-en-Y reconstruction. The patient had no complications after the operation and was discharged postoperative day 15. Clinical discussion Gastric cancer is an aggressive disease that requires timely diagnosis and appropriate intervention. Unfortunately, many patients present late with gastric cancer and do not benefit from surgical or other appropriate interventions. Patients who are eligible for surgery however still need a clean marginal resection to maximize prognosis, which is not always possible due to complex anatomy or variations as seen in situs inversus totalis. DaVinci robotic surgery system is a new generation of minimally invasive operating systems after conventional laparoscopy, and its visual field clarity, operating flexibility, and instrument stability have obvious advantages over conventional laparoscopic surgery and traditional open surgery. Conclusion Robotic surgery for situs inversus totalis (SIT) patients is more advantageous than laparoscopic and traditional surgeries as it offers a broader view of the variant anatomy and allows optimum dexterity and clarity.
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Affiliation(s)
- Eugene Abbey
- First Affiliated Hospital of Zhengzhou University, 450000 Jianshe Street, Erqi District, Zhengzhou, Henan, China; Gastrointestinal Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Fu Yang
- First Affiliated Hospital of Zhengzhou University, 450000 Jianshe Street, Erqi District, Zhengzhou, Henan, China; Gastrointestinal Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
| | - Liu Qi
- First Affiliated Hospital of Zhengzhou University, 450000 Jianshe Street, Erqi District, Zhengzhou, Henan, China; Gastrointestinal Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jiang Jian Wu
- First Affiliated Hospital of Zhengzhou University, 450000 Jianshe Street, Erqi District, Zhengzhou, Henan, China; Gastrointestinal Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Li Tong
- First Affiliated Hospital of Zhengzhou University, 450000 Jianshe Street, Erqi District, Zhengzhou, Henan, China; Gastrointestinal Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhang Zhen
- First Affiliated Hospital of Zhengzhou University, 450000 Jianshe Street, Erqi District, Zhengzhou, Henan, China; Gastrointestinal Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Sureka B, Jha S, Yadav A, Varshney V, Soni S, Vishnoi JR, Yadav T, Garg PK, Khera PS, Misra S. MDCT evaluation of pancreatic contour variations in head, neck, body and tail: surgical and radiological significance. Surg Radiol Anat 2021; 43:1405-1412. [PMID: 33738524 DOI: 10.1007/s00276-021-02735-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of the study was to investigate the incidence of pancreatic contour variations on multidetector CT (MDCT) for abdominal examinations. METHODS A retrospective analysis of 700 MDCT scans was performed in patients who underwent triple phase CT abdomen between October 2018 and January 2021. After excluding 176 patients, finally total of 524 patients were included in the study. For simplification, we classified the pancreatic contour variations as classified by Ross et al. and Omeri et al. Pancreatic head-neck variations was classified into Type I-anterior, Type II-posterior and Type III-horizontal variety. Pancreatic body-tail variation was divided into Type Ia-anterior projection; Ib-posterior projection and Type IIa-globular, IIb-lobulated, IIc-tapered, and IId-bifid pancreatic tail. RESULTS The most common type of variation in the head was Type II (n = 112, 21.3%) followed by Type III (n = 37, 7%) and Type I (n = 21, 4%). The most common type of variation in the body of pancreas was Type Ia (n = 33, 6.2%) followed by Type Ib (n = 13, 2.4%). In the tail region of pancreas, the most common variation was Type IIb (n = 21, 4%) followed by Type IIa (n = 19, 3.6%). CONCLUSION Pancreatic contour variations are not very uncommon in daily practice. Knowledge of these variations is important for surgeons, radiologists and avoids misjudgement of normal pancreatic tissue as tumor or lymph node especially on unenhanced or single phase MDCT.
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Affiliation(s)
- Binit Sureka
- Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, 342005, India.
| | - Satya Jha
- Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, 342005, India
| | - Arushi Yadav
- Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, 342005, India.,Department of Radiodiagnosis, GMC Chandigarh, Chandigarh, India
| | | | - Subhash Soni
- Department of Surgical Gastroenterology, AIIMS, Jodhpur, India
| | | | - Taruna Yadav
- Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, 342005, India
| | - Pawan Kumar Garg
- Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, 342005, India
| | | | - Sanjeev Misra
- Department of Surgical Oncology, AIIMS, Jodhpur, India
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Inferior vena cava anomalies: review and surgical considerations. ANGIOLOGIA 2021. [DOI: 10.20960/angiologia.00282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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14
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Popov Z, Stankov O, Stavridis S, Saidi S, Ivanovski O, Spasovski G, Cakalaroski K, Ivanovski N. Management of Multiple Renal Arteries and Unusual Venous Anatomy During Kidney Transplant: From a Simple Technical Problem to a Graft-Saving Procedure. EXP CLIN TRANSPLANT 2020; 18:763-770. [PMID: 33349206 DOI: 10.6002/ect.2019.0314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Incidence of vascular anomalies in donor kidneys varies from 18% to 30% and presents a challenge for a transplant surgeon in kidney transplant. Here we present our personal experience for man - agement of the complicated and unexpected cases. MATERIALS AND METHODS A total of 250 kidney transplants (226 living, 24 deceased) were performed in a period of 24 years; mean donor age was 55 years (range, 25-86 years), and mean recipient age was 38.6 years (range, 14-66 years). We analyzed the surgical techniques, complications and outcomes, rejection episodes, kidney function, and graft and patient survival rates. RESULTS Of 250 nephrectomies, 209 had a single artery (83.6%), 34 had 2 arteries (13.6%), and 7 had 3 arteries (2.8%). Of 34 double arteries, 14 had 2 main arteries, 15 had a main and a polar artery, and 5 had an aortic Carrel patch after deceased donation. According to the size, type, and position, the anastomoses were performed with branches of hypogastric, epigastric inferior, iliac external, and main renal artery, intracorporeally or in bench surgery. Regarding veins, 1 double inferior vena cava, 1 left-side inferior vena cava, 4 retroaortic, 2 circumaortic, 10 large lumbar veins draining into the left renal veins, and 8 cases with 2 or more different size renal veins were managed. In 9 cases with short right renal vein, an extension with vena cava (a "Barry cavoplasty") was performed in deceased donor organs. No serious surgical complications related to vascular anomalies were observed. There were no statistical differences in 1-, 6-, and 12-month graft survival rates between the groups with or without vascular anomalies. CONCLUSIONS Vascular anomalies should no longer be considered a contraindication for transplant, if careful anastomosis is performed in every case to avoid ischemia and further complications. Therefore, management of vascular anomalies could be a graftsaving procedure.
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Affiliation(s)
- Zivko Popov
- From the Medical Faculty, University Saints Cyril and Methodius Skopje, North Macedonia.,From the Macedonian Academy of Sciences and Arts, Skopje, North Macedonia
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15
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Hoff M, Leighton P, Hosgood SA, Nicholson ML. Anastomosis of dual renal transplant veins. J Surg Case Rep 2020; 2020:rjaa310. [PMID: 32963761 PMCID: PMC7490215 DOI: 10.1093/jscr/rjaa310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/13/2020] [Indexed: 11/17/2022] Open
Abstract
As there is usually considerable overlap in the renal venous drainage, it is often possible to ligate supernumerary transplant renal veins in order to simplify the implantation procedure. Nonetheless, decisions about whether to implant multiple veins can be difficult and are usually made subjectively. Here, we describe the use of intraoperative Doppler ultrasound as an adjunct to decision-making when there are two renal veins and a novel technique for the sequential anastomosis of dual veins. The kidney was reperfused after anastomosis of the main renal vein with the second vein clamped. On-table Doppler ultrasound demonstrated reversed flow in diastole indicating that the second renal vein also needed to be anastomosed. By clamping the external iliac vein inferior to the first venous anastomosis it was possible to complete the lower polar renal vein anastomosis to the external iliac vein without interrupting the perfusion of the kidney.
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Affiliation(s)
- Mekhola Hoff
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Philippa Leighton
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Sarah A Hosgood
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Michael L Nicholson
- Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
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16
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Fananapazir G, Tse G, Di Geronimo R, McVicar J, Perez R, Santhanakrishnan C, Sageshima J, Troppmann C. Urologic complications after transplantation of 225 en bloc kidneys from small pediatric donors ≤20 kg: Incidence, management, and impact on graft survival. Am J Transplant 2020; 20:2126-2132. [PMID: 31984616 DOI: 10.1111/ajt.15792] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/13/2020] [Accepted: 01/20/2020] [Indexed: 01/25/2023]
Abstract
Pediatric en bloc kidney transplants (EBKs) from small deceased pediatric donors are associated with increased early graft loss and morbidity. Yet, urologic complications post-EBK and their potential impact on graft survival have not been systematically studied. We retrospectively studied urological complications requiring intervention for 225 EBKs performed at our center January 2005 to September 2017 from donors ≤20 kg into recipients ≥18 years. Overall ureteral complication incidence after EBK was 9.8% (n = 22) (12% vs 2% for EBK donors < 10 vs ≥ 10 kg, respectively [P = .031]). The most common post-EBK urologic complication was a stricture (55%), followed by urine leak (41%). In all, 95% of all urologic complications occurred early within 5 months posttransplant (median, 138 days). Urologic complications could be successfully managed nonoperatively in 50% of all cases and had no impact on graft or patient survival. In summary, urologic complications after EBK were common, associated with lower donor weights, occurred early posttransplant, and were often amenable to nonoperative treatment, without adversely affecting survival. We conclude that the higher urologic complication rate after EBK (1) should not prevent increased utilization of small pediatric donor en bloc kidneys for properly selected recipients, and (2) warrants specific discussion with EBK recipients during the preoperative consent process.
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Affiliation(s)
- Ghaneh Fananapazir
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
| | - Gary Tse
- Department of Radiology, Long Beach Medical Center, Long Beach, California
| | - Ryan Di Geronimo
- Department of Radiology, University of California Davis Medical Center, Sacramento, California
| | - John McVicar
- Department of Surgery, University of California Davis Medical Center, Sacramento, California
| | - Richard Perez
- Department of Surgery, University of California Davis Medical Center, Sacramento, California
| | | | - Junichiro Sageshima
- Department of Surgery, University of California Davis Medical Center, Sacramento, California
| | - Christoph Troppmann
- Department of Surgery, University of California Davis Medical Center, Sacramento, California
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17
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Shampain KL, Liles AL, Chong ST. Imaging of Transplant Emergencies. Semin Roentgenol 2020; 55:115-131. [PMID: 32438975 DOI: 10.1053/j.ro.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Amber L Liles
- Department of Radiology, Michigan Medicine, Ann Arbor, MI
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18
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Troubleshooting Complex Vascular Cases in the Kidney Graft: Multiple Vessels, Aneurysms, and Injuries During Harvesting Procedures. Curr Urol Rep 2020; 21:5. [PMID: 32006250 DOI: 10.1007/s11934-020-0955-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF THE REVIEW To update the most relevant literature regarding complex vascular cases in kidney transplant setting involving the graft, especially during the harvesting procedure and back-table preparation from the subsequent implant. RECENT FINDINGS Challenging situations affecting the kidney graft such as multiple vessels, renal artery aneurysms, kidney anatomical anomalies, or major injuries do not contraindicate the transplant, but require an exhaustive graft viability assessment and several bench surgery techniques. Graft vessel conditioning in the back-table might include simple anastomosis between them, enlarging with venous patch or reconstruction with donor or synthetic grafts. Compared with conventional transplant, literature reports longer warm ischemia time (40 vs 32 min) and slightly increased rates of delayed graft function (10.3% vs 8.2%) and vascular complications (10.8% vs 8.1%), but similar graft and patient survival. Kidney graft vascular complex cases require exhaustive assessment, meticulous harvesting, good surgical technique in the bench table, and proper surgery in the recipient. Despite its complexity, vascular complex kidney transplant offers comparable outcomes in the long term to conventional population when technically well performed, with slightly increased rates of vascular complications and delayed graft function.
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19
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Covantev S, Mazuruc N, Belic O. The Arterial Supply of the Distal Part of the Pancreas. Surg Res Pract 2019; 2019:5804047. [PMID: 31016226 PMCID: PMC6446113 DOI: 10.1155/2019/5804047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/25/2019] [Indexed: 12/14/2022] Open
Abstract
The pancreatic surgery field has evolved greatly over the previous years. Nevertheless, the vascularization of the pancreas remains a difficult subject and requires further attention. The study was conducted using macroscopical dissection and corrosion cast methods. The total number of organ blocks was 72 (50 for dissection and 22 for corrosion cast). Based on the data obtained by dissection, we can distinguish three major types of vascularization of the distal pancreas. In type one, the pancreas was vascularized only by the short branches of the splenic artery and was encountered in 18 cases (36%). In type two, the pancreas was vascularized by the long and short branches of the splenic artery and was encountered in 20 cases (40%). In type three, the pancreas was vascularized only by the long branches of the splenic artery in 12 cases (24%). Compared to that, the corrosion cast method demonstrated type 1 in 8 cases (36.36%), type 2 in 10 cases (45.46%), and type 3 in 4 cases (18.18%). During the dissection, there were no arteries to the tail of the pancreas in 13 (26%) cases, one artery in 15 (30%) cases, two arteries in 19 (38%), and three arteries in three (6%) cases. The 22 corrosion cast specimens were also evaluated based on the classification of Roman Ramos and coworkers. Type I (small arcades) was in 9 (40.90%) cases, type II (small and large arcades) was in 7 (31.82%) cases, type III (large arcades) was in 5 (22.73%) cases, and type IV (straight branches) was in 1 (4.55%) case. The corrosion cast method allowed us to determine no arteries to the tail in 4 (18.18%) cases, one artery in 6 (27.27%) cases, two arteries in 10 (45.46%) cases and three arteries in two (9.09%) cases. The vascularization of the distal part of the pancreas is highly variable and should be taken into consideration during surgery.
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Affiliation(s)
- S. Covantev
- Laboratory of Allergology and Clinical Immunology, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
| | - N. Mazuruc
- Department of Human Anatomy, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
| | - O. Belic
- Department of Human Anatomy, State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chisinau, Moldova
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20
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Mazuruc N, Covantev S, Belic O. A Case of Unusual Vascularization of Upper Abdominal Cavity' Organs. Case Rep Vasc Med 2018; 2018:5738037. [PMID: 30515342 PMCID: PMC6234457 DOI: 10.1155/2018/5738037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/16/2018] [Accepted: 10/24/2018] [Indexed: 12/21/2022] Open
Abstract
We describe a case report of multiple arterial variations of internal organs of upper abdominal cavity in a cadaver of 63-year-old female. There were several developmental variations of the vascular supply of the stomach, pancreas, spleen, and liver. There were several accessory arteries: left gastric, left hepatic, and posterior gastric artery as well as several arteries that had abnormal origin. The variations were discovered during macroscopical dissection at the department of human anatomy. It should be noted that multiple developmental variation can be common in clinical practice and clinicians should be aware of them during diagnostic and interventional procedures.
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Affiliation(s)
- Natalia Mazuruc
- Department of Human Anatomy, State University of Medicine and Pharmacy «Nicolae Testemitanu», Chisinau, Moldova
| | - Serghei Covantev
- Laboratory of Allergology and Clinical Immunology, State University of Medicine and Pharmacy «Nicolae Testemitanu», Chisinau, Moldova
| | - Olga Belic
- Department of Human Anatomy, State University of Medicine and Pharmacy «Nicolae Testemitanu», Chisinau, Moldova
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21
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Vasconcelos Ordones F, Yamamoto H, Ivo Pajolli P, Ribeiro Meduna R, Ferreira Gomes Filho F, Guerra R, Luiz Amaro J, Roberto Kawano P. Transplanting a horseshoe kidney: A case report and review of surgical strategies. Urol Case Rep 2018; 21:119-121. [PMID: 30294550 PMCID: PMC6168959 DOI: 10.1016/j.eucr.2018.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 09/17/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Flávio Vasconcelos Ordones
- Dept of Urology, Botucatu School of Medicina, Univ. Estadual Paulista, UNESP, Botucatu, Brazil.,Bp Hospital, São Paulo, Brazil.,Oswaldo Cruz Hospital, São Paulo, Brazil.,Sírio Libanês Hospital, São Paulo, Brazil.,Royal Adelaide Hospital, Adelaide, Australia
| | - Hamilto Yamamoto
- Dept of Urology, Botucatu School of Medicina, Univ. Estadual Paulista, UNESP, Botucatu, Brazil
| | - Pedro Ivo Pajolli
- Dept of Urology, Botucatu School of Medicina, Univ. Estadual Paulista, UNESP, Botucatu, Brazil
| | | | | | - Rodrigo Guerra
- Dept of Urology, Botucatu School of Medicina, Univ. Estadual Paulista, UNESP, Botucatu, Brazil
| | - Joao Luiz Amaro
- Dept of Urology, Botucatu School of Medicina, Univ. Estadual Paulista, UNESP, Botucatu, Brazil
| | - Paulo Roberto Kawano
- Dept of Urology, Botucatu School of Medicina, Univ. Estadual Paulista, UNESP, Botucatu, Brazil
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22
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Mishra A, Lo A, Lee GS, Samstein B, Yoo PS, Levine MH, Goldberg DS, Shaked A, Olthoff KM, Abt PL. Liver paired exchange: Can the liver emulate the kidney? Liver Transpl 2018; 24:677-686. [PMID: 29427562 DOI: 10.1002/lt.25030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/14/2018] [Accepted: 02/05/2018] [Indexed: 02/07/2023]
Abstract
Kidney paired exchange (KPE) constitutes 12% of all living donor kidney transplantations (LDKTs) in the United States. The success of KPE programs has prompted many in the liver transplant community to consider the possibility of liver paired exchange (LPE). Though the idea seems promising, the application has been limited to a handful of centers in Asia. In this article, we consider the indications, logistical issues, and ethics for establishing a LPE program in the United States with reference to the principles and advances developed from experience with KPE. Liver Transplantation 24 677-686 2018 AASLD.
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Affiliation(s)
- Ashish Mishra
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Alexis Lo
- Temple University School of Medicine, Philadelphia, PA
| | - Grace S Lee
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.,Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA
| | - Benjamin Samstein
- Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY
| | - Peter S Yoo
- Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Matthew H Levine
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - David S Goldberg
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA.,Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Abraham Shaked
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Kim M Olthoff
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Peter L Abt
- Division of Transplant, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
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23
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24
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Moreno CC, Mittal PK, Ghonge NP, Bhargava P, Heller MT. Imaging Complications of Renal Transplantation. Radiol Clin North Am 2015; 54:235-49. [PMID: 26896222 DOI: 10.1016/j.rcl.2015.09.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Renal transplant complications are categorized as those related to the transplant vasculature, collecting system, perinephric space, renal parenchyma, and miscellaneous complications including posttransplant lymphoproliferative disorder. Many of these renal transplant complications are diagnosed with imaging. Medical complications including rejection, acute tubular necrosis, and drug toxicity also can impair renal function. These medical complications are typically indistinguishable at imaging, and biopsy may be performed to establish a diagnosis. Normal transplant anatomy, imaging techniques, and the appearances of renal transplant complications at ultrasound, computed tomography, and MR imaging are reviewed.
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Affiliation(s)
- Courtney Coursey Moreno
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road, NE, Atlanta, GA 30322, USA.
| | - Pardeep K Mittal
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road, NE, Atlanta, GA 30322, USA
| | - Nitin P Ghonge
- Department of Radiology, Indraprastha Apollo Hospitals, Delhi-Mathura Road, New Delhi 110076, India
| | - Puneet Bhargava
- Department of Radiology, VA Puget Sound Health Care System, University of Washington Medical Center, 1959 NE Pacific Street, Room BB308, Box 357115, Seattle, WA 98195-7115, USA
| | - Matthew T Heller
- Department of Radiology, University of Pittsburgh School of Medicine, 200 Lothrop Street, Suite 174E PUH, Pittsburgh, PA 15213, USA
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