Vein cuff interposition for short renal vein in living-donor kidney transplantation: Three case reports and review of literature

Figure 1 Fabrication of the vascular cuff and related surgical diagrams for case 1. A: Creation of a cylindrical vascular cuff. a1: Longitudinal opening; a2: Syringe molding of the donor’s gonadal vein for renal vein extension; B: Venous cuff fashioned from the donor’s gonadal vein, modeled into a tubular shape, and anastomosed end-to-end to the donor’s renal vein to achieve venous extension. b1: Schematic illustration; b2: Perioperative image; C: Anatomical configuration of renal allograft in the right iliac fossa. End-to-side anastomosis of the reconstructed renal vein via gonadal venous cuff to the external iliac vein and renal artery to external iliac artery. c1: Schematic illustration; c2: Perioperative image; D: View following declamping and graft repositioning. d1: Significant tension present at the venous anastomosis site; d2: Bleeding observed at the level of the reconstructed venous cuff; E: After identifying bleeding at the venous anastomosis, the iliac vessels were reclamped, and the external iliac artery was transected to facilitate graft flushing and maintain perfusion. e1: Schematic illustration; e2: Perioperative image; F: Harvesting of the recipient’s saphenous vein in the right groin and reconstruction of the venous cuff. f1: Schematic illustration; f2: Perioperative image; G: Anatomical configuration of renal allograft in the right iliac fossa. End-to-side anastomosis of the reconstructed renal vein via saphenous venous cuff to the external iliac vein and renal artery to the external iliac artery. g1: Schematic illustration; g2: Perioperative image.

Figure 2 Images related to case 2. A: Back-table construction of a patch graft using gonadal vein for renal vein lengthening and diameter augmentation. a1: Harvesting the gonadal vein; a2: Cutting the gonadal vein longitudinally; a3: Positioning the gonadal vein graft with the intimal surface facing up; a4: Suturing the posterior wall; B: Renal vein reconstruction. b1: Anterior wall closure of the gonadal vein patch; b2: Final shaping; C: Anatomical configuration of renal allograft in the right fossa. End-to-side anastomosis of the reconstructed renal vein using a gonadal vein cuff to the external iliac vein and the renal artery to the external iliac artery.

Figure 3 Images related to case 3. A: Intrahilar renal vein measuring < 1.0 cm, complicating venous anastomosis; B: Anatomical configuration of renal allograft in the right iliac fossa. End-to-side anastomosis of the reconstructed renal vein via the gonadal venous cuff to the external iliac vein and the renal artery to the external iliac artery.