Table 2.

Different techniques of vascular reconstruction.

Vascular Reconstruction Techniques of Severed Polar Artery	Indication	Method	Advantages	Disadvantages
Ligation	Upper polar artery which supplies < 25% is severed	Ligation	Does not affect the function of the graft	Cannot be applied for the lower polar artery
Direct repair	Distal end of the polar artery is preserved	Connection of two interrupted segments of the polar artery	Does not require additional vessels	Possible only if the aortic patch with polar artery bifurcation is retained
End-to-side anastomosis	Distal end of the polar artery is severed	End-to-side anastomosis with the main renal artery, external iliac artery, or internal iliac artery	The diameters of vessels can be different	If back-table preparation is not used, warm ischemia time is prolonged Higher risk of stenosis and thrombosis
End-to-end anastomosis	Distal end of the polar artery is severed	End-to-end anastomosis with hypogastric artery	Can be anastomosed after the main renal artery is reperfused Reduces ischemia time	The hypogastric artery is not always available due to atherosclerosis The size or diameter can be insufficient
Side-to-side conjoined anastomosis	Two equal-sized arteries	Common ostium is made with another renal artery	Reduction in warm ischemia time due to single artery anastomosis	Arteries need to be comparable in size
Vascular interposition graft	Insufficient artery length	Vascular interposition graft is made from donor or recipient’s vessel (saphenous vein, internal iliac artery, inferior epigastric artery, or gonadal vein) or PTFE; it is anastomosed to the severed polar artery and a larger vessel	No additional intraoperative or donor-site complications Decreases warm ischemia time due to back—table preparation	Saphenous vein graft has a higher risk of occlusion, aneurysms, and ruptures, and access to the vein requires an additional incision PTFE has the highest rate of thrombogenicity and infectability