0:00

So this is adult patient who actually

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received a pediatric enblock renal transplant

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and I wanted to show you this ultrasound just so

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you get a sense of what this looks like, you know, we don't do these that

0:12

often and so whenever we do these it's important just sort

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of refresh your memory of what these could look like and

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so like all renal transplant ultrasounds. We

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start off by looking at the grayscale image and this is a transplant place

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in the right lower quadrant, and we've sort of annotated in

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this instance the kidneys as the lateral kidney in the medial kidney.

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I think it's important to be consistent with

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that annotation. Whatever you end up choosing for the first ultrasound that

0:36

you perform in the patient sort of try your best to sort of

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use those annotations moving forward so that all the people interpreting

0:42

those ultrasounds can be consistent and so you can actually see

0:45

through kidneys over here one over here the lateral one

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and one over here. It's the medial one that's supposed to one kidney which

0:51

you have would have when an adult a donor gives it

0:54

to an adult recipient. So that's the gray scale image. We're looking for Mass

0:57

this collections higher than it for us. At least on this image. You're not seeing much

1:00

here.

1:00

We do interrogate the vessels and all these patients.

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And so this is sort of interesting in that here your

1:07

evaluating the main needle already anastomosis, but what

1:10

needs to be remembered that the anastomosis is not really from the

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donors native renal arteries to

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the external iliac artery. The anastosis

1:19

is actually

1:20

from the donors aorta which

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is grafted alongside the

1:26

renal transplanted itself. And that's what's an ass

1:29

to most to the external AI card and that's when parentheses it says

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AO for aorta that's a that's actually what we're interrogating in

1:35

this instance. And so nachos pretty good waveform of appropriate

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velocities over here, you know, we're trying to reevaluate in

1:41

different instances and then you're sort of working your way up that donor

1:44

aorta to show that the velocities are reasonably within

1:47

normal limits as you work your way up

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to 18 over here. We're going a little bit higher up

1:53

into the area where the donor aorta

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is now meeting the renal arteries of the

1:59

Pediatric on block, you know transplant, we're all so

2:02

now moving back to the pre and asked most so this would be the external iliac

2:05

artery and our recipient the extra artery post

2:08

and ask the most in our recipient all good waveforms. We do

2:11

move on to the main renal vein and while

2:14

it is annotated mainly remember at the anastomouse is

2:17

actually takes place between the donor IVC, which is harvested.

2:20

Side the Pediatric on block

2:23

at transplant and that's what's an Asta most to the external iliac

2:26

vein. So that and asthmosis looks open they've lost

2:29

these are appropriate and we sort of interrogate pre

2:32

and post anastomosis in the external iliac vein. Those

2:35

velocities are appropriate. We work our way up the main renal Lane to

2:38

make sure that those velocities are appropriate that the

2:41

vessel is patent. We then sort of interrogate the intraprenchymal

2:44

arteries within both renal transplants.

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In this instance. This is the one that's probably more lateral and

2:50

here we're looking at the renal veins and there is renal venous

2:53

flow over here here in the upper pole areas. We're

2:56

looking at the arteries appropriate sharp systolic up

2:59

Strokes.

3:00

You know some degree of diastolic flow. But again, it's on the

3:03

lower end in this instance, which is why the resistive index is a little bit higher than

3:06

you would like. And so that's something one would certainly have to watch again.

3:09

When we look at another segment of one of the

3:12

renal transplants Sharps systolic up Strokes with anti-stolic velocities,

3:16

which are a little bit lower than what we like resulting in a high resistive

3:19

index to 0.82 again, not exactly appropriate. But

3:22

again, you'd have to watch this and see what happens over

3:25

time.

3:26

Here we're now evaluating the veins at

3:29

the other transplant the one that's more lateral evaluating. Some

3:32

of the arteries here again resistance are on the higher side.

3:35

And again other portions of the inner lower arteries again resist

3:38

indices that are top normal for this patient as well.

3:42

And so that's sort of what you do you sort of look at

3:45

the anastomoses remembering the anastomosis takes place

3:48

between the donor aorta and IVC and the recipient external

3:51

iliac artery and external iliac pain respectively your work

3:54

your way up those vessels to make sure that the velocities and color

3:57

flows appropriate. Then you integrate inside both on

4:00

block renal transplants to make sure that the

4:03

velocities and waveforms are within normal limits.

4:06

Now this patient happened to have a CTS well, and I wanted to

4:09

show the CT just to give you a sense of some of

4:12

the anatomy because it's sometimes can be a little bit confusing

4:15

if you haven't seen it on ultrasound before and so

4:18

first of all, we can see patient has polycystic kidney

4:21

disease and that's really the reason for them getting the transplant.

4:24

You can see these

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Pediatric transplants in the right lower quadrant. This

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is the one over here and another one over here.

4:31

And this is the renal arteries coming

4:34

from the renal transplant over here.

4:37

And you have one coming over here as well. They're sort

4:40

of joining the donors aorta which is this and that's

4:43

the vessel. That's anastomosing to the external iliac

4:46

artery similarly over here. You can see the renal veins

4:49

coming from both these tribes one small one over there.

4:52

Another one over here, and these will join

4:55

the donor IVC which then anastomosis to the

4:58

external iliac vein over here.