Complex vascular anatomy has always posed a challenge to the surgical skills of the operating team
5. Previous studies showed that incidence of multiple renal arteries in the general population is 18% to 30%
6. In our experience, the incidence of multiple renal arteries was 16 %. Transplanting a kidney with multiple renal arteries has several disadvantages, including prolonged warm ischemia time, high incidence of acute tubular necrosis and rejection episodes, high graft function failure, and prolonged hospitalization. Multiple renal arteries have reportedly been associated with a higher rate of vascular complications, including arterial thrombosis and renal artery stenosis
6-9. Several techniques for bench or in situ reconstruction of multiple renal arteries have been described in order to reduce the incidence of these vascular complications
10. In grafts from cadaver donors, the Carrel aortic patch is the standard technique of vascular reconstruction in renal transplants with a single and multiple arteries
11. In kidney transplants with multiple anastomoses, revascularization can be done either simultaneously after the entire arterial engraftment is completed or sequentially. Using the latter technique, the main renal artery is revascularized first. Then, the vascular clamps are released and the kidney is partially revascularized. The other artery is anastomosed to a convenient site, maintaining perfusion of the kidney by the main artery. Even though an aortic patch theoretically should make the vascular anastomosis easier and prevent stenosis, the presence of a patch did not decrease the incidence of renal artery stenosis for grafts with a single artery. The other complications are posttransplant hypertension, rejection, urologic complications, such as ureteral necrosis or calyceal cutaneous fistulas related with delayed graft function.
Therefore, kidneys with multiple arteries should be implanted, using the technique that best fits a particular situation and with which the individual transplant surgeon feels most comfortable.