Alternative techniques for arterialization in multivisceral grafting.

Abstract For a small group of carefully selected patients, multivisceral grafting is a viable treatment. While early data suggest that the 3-year survival is less than 50%, 1 it is unlikely that any of these patients would have survived without transplantation. While improving results rely on advances in management, particularly in technique and immunosuppression, it is essential that the acquisition of the multivisceral graft does not compromise the procurement of the donor kidneys for transplantation. Described techniques generally employ the use of an aortic conduit or large aortic patch, 2,3 but these techniques have a number of drawbacks. For example, the use of the aortic conduit compromises the aortic patch around the orifices of the donor renal arteries which is a particular problem if there are multiple renal arteries. In addition, these techniques require mobilization of a long length of recipient aorta, often appear cumbersome, and can be difficult to orientate satisfactorily. In addition, the thoracic aorta needs to have the multiple intercostal arteries oversewn. If an aortic patch bearing the origins of the celiac and superior mesenteric arteries is used, the short length of vessels can make the anastomosis of the patch to recipient aorta difficult and hazardous.