Figure 1414

Isolation of the arteriotomy site. Heparin (30-50 U/kg) is administered intravenously, and vascular clamps are placed on the external iliac artery. The distal clamp is applied first so that the arterial pressure will distend the targeted artery. The external iliac artery is incised longitudinally, the lumen is irrigated with heparinized saline, and fine monofilament vascular sutures are placed in four quadrants to receive the spatulated renal artery. When the recipient artery has significant arteriosclerosis, an endarterectomy can be done or a 5- or 6-mm aortic punch can be used to create a smooth round arteriotomy.

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