0:00

This is a patient who's fresh out of the operating room

0:03

of the renal transplant. And so it our institution

0:06

when patients get these renal transplants. Essentially. It's

0:09

post-operative Day Zero they come and we do

0:12

an ultrasound of them. And so I wanted to show a case to show

0:15

you sort of what we're looking for in the immediate

0:18

post-operative setting once they've placed these transplants in

0:21

the patient. And so we evaluate in a very

0:24

similar manner. You can see starting off with grayscale. Imaging. This is a transman

0:27

that's placed in the right level quadrant on the grayscale images.

0:30

I'm sort of measuring the length here in this

0:33

case about 10 and change 10.5 centimeters. I'm looking

0:36

for big collections that are surrounding the kidney and looking

0:39

for if there's any mass or anything like that which would be very unusual

0:42

but still you need to sort of do your due diligence

0:45

and look for it. I'm looking to see if there's any hydrogenfrosis within

0:48

the renal transplant in this case. This looks pretty good.

0:52

I certainly want to get a color image that shows that there's color

0:55

flow throughout the renal transplant. So as soon as it's placed and

0:58

they place these anastomoses you want to make sure that there's flow throughout

1:01

the entire renal transplant.

1:03

Thereafter we're going to sort of make sure

1:06

that there's some Venus flow. You can see here beautifully going away from

1:09

the kidney and this instance.

1:13

We're going to then interrogate the parenchymal vessels

1:16

of the renal transplant to ensure that there is

1:19

appropriate flow and appropriate waveforms. And so in

1:22

this instance, we're going again at the upper pole segmental

1:25

renal artery that has a beautiful

1:28

sharpest all the cups Joe appropriate velocities of

1:31

resistive index, which is very appropriate. It's 0.72 until

1:34

we like that that's very reassuring for us.

1:38

We're also going to go there to the interloball arteries a little

1:41

bit more cephalic to make sure that the vessels there also look appropriate. This

1:44

looks completely appropriate and so we're really happy with the renal

1:47

transplant over here the same time we're going to go and look at

1:50

the renal veins in the parenchymal make sure that there's nice venous flow

1:53

remembering that it's monophasic but can be sometimes positive

1:56

particularly in the postoperative setting due to

1:59

the patient's cardiac status. And then of course we can do the

2:02

same thing in the lower pole arteries. And so there's nice Venus low in the lower pole. It's

2:05

like mental arteries. Look beautiful nice systolic upstroke

2:08

knife flow and die slowly the interloball arteries

2:11

look great. And so, you know just looking at these vessels inside

2:14

the kidney. I'm very reassured that this

2:17

kidneys working well in the post-operative setting it's getting appropriately

2:20

perfused. I don't see masses. I don't see collections. I don't see higher and

2:23

ferocious. We're then gonna sort of interrogate the renal artery

2:26

itself renal pain as well as the external iliac

2:29

artery in vain and so in this instance, we've gone straight to

2:32

the external iliac thing prior to the anastomosis looks

2:35

beautiful good flow.

2:37

And no thrombus. We see the external iliac

2:40

artery post anastomosis looks very good with sharp

2:43

systolic upstrokes. Pre-anastomosis looks pretty

2:46

good as well.

2:47

Velocity of 153 post iliacomastomosis

2:50

again. We're just looking to see

2:53

if there's flow. We're really looking at Big Picture stuff.

2:56

And one of the things I wanted to show this case was to point

2:59

out that in the post-operative setting some of the velocities you

3:02

may see within the real arteries and even within the renal

3:05

veins, maybe much higher than you'd expect. So in

3:08

this instance remember prenas to most is philosophy is

3:11

about 1:15 as you get through an art or you're jumping

3:14

up almost two full to 331.

3:16

Here are 356 when you evaluate the

3:19

mid renal artery at the anastomosis 3:19. And so that ratio

3:22

is not quite worrisome for renal

3:25

arteries stenosis, you know real information ratio of you know, jumping from

3:28

the velocity of say 100 to like 300

3:31

or 400. So this is less than

3:34

that ratio, but it is a significant jump but

3:37

that is not unreasonable to see the postoperative setting

3:40

often in the post opportunity setting you have a lot of Edema which Narrows

3:43

vessels and so you could see these elevations in velocities,

3:46

but that may be appropriate and the best

3:49

thing to do. This instance is reported mention that

3:52

it may be seen in the post-operative setting and just follow it get

3:55

another one a couple of hours later another one a day later and most likely

3:58

you'll see that these velocities improve it the edema sort

4:01

of subsides in the first couple days similarly

4:04

in this instance, you know, the main renal vein velocity is

4:07

about 23 over here 29 in the mid portion.

4:10

But if you ask the most is it sort of jumps up to 191 just

4:13

kind of high here 424 and so, you

4:16

know,

4:16

Whereas you maybe worried about some sort of kinking at that

4:19

anastomosis. And in reality that may always be present. It's

4:22

important to remember to sort of perhaps downplay that

4:25

a little bit in the post-operative setting especially post-operative

4:28

day Zero where edema can result in narrowing of

4:31

the vessels in that location here at 379 until in

4:34

this instance. That's how it was reported and in

4:37

subsequent ultrasounds a day or two later with the

4:40

edema subsiding these velocities became all within normal range. Finally. We

4:43

have a look at the bladder which in this instance is collapse trying to

4:46

fully catheter which we can see over here.