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A report on one of the more vexing problems facing surgeons involved in the transplantation of the kidney in man--the question of the joining of arterial and venous blood vessels--was offered recently by Dr. George T. Smith of the Harvard Medical School at the 57th annual meeting of the American Urological Association.
Dr. Smith's study was undertaken to determine whether certain pathological patterns observed microscopically in kidney transplants could be explained on the basis of abnormal blood flow. The individual joining together of all venous and arterial vessels in the course of a kidney transplant, he noted, placed a number of vessels is close proximity and increased the likelihood of stretching and kinking which, he said "may dispose to thrombosis."
The basic problem confronting the surgeon in kidney transplantation in man has been the irregular numbers of venous and arterial vessels seen in the kidneys of the donor and recipient. As an example, the donor kidney may have more than the normal number of venous or arterial vessels, and the surgeon must decide whether to join or ligate (tie off) the irregular vessels.
In the studies of the vascular patterns in 100 human kidneys, Dr. Smith has concluded:
* That the tieing off of an irregular (extra) vein, either in the kidney or the recipient, is not likely to embarrass the circulation of blood through the kidney as numerous intra-renal by-passes are present. But --
* The tieing off of irregular arterial vessels is likely to lead to infarction (destruction through lack of oxygenated blood) or atrophy (malfunction through an insufficient arterial blood supply of a segment of the kidney, proportional to the diameter of the artery involved, as there are no intra-renal capallary by-passes present in the organ.)
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