R M Taylor1. 1. Department of Surgery, Royal Victoria Infirmary, Newcastle Upon Tyne, England.
Abstract
BACKGROUND: In 1996, a court in the United Kingdom ruled against a plaintiff who claimed that: (1) division of both internal iliac arteries at separate renal transplant operations had made him impotent and (2) the risk of his becoming impotent was sufficiently high that he should have been warned. The court ruled that there was not enough evidence in the medical literature to allow his claim to succeed. METHODS: A survey of the views of transplant surgeons in the United Kingdom and Ireland on attitudes toward using the internal iliac artery for transplantation was conducted. RESULTS: A 100% response rate was received. In a potent male patient, 11% of surgeons would never use the first internal iliac artery and 52% would use it infrequently. If one internal iliac artery had already been used, 61% would never use a second and 34% would use it infrequently. Eighty-nine percent believed the risk of impotence when the second internal iliac artery was used was 25% or higher, and 91% thought the risk should be explained to the patient. CONCLUSION: A very strong opinion exists among transplant surgeons in the United Kingdom and Ireland that the second internal iliac artery should not be used to revascularize a kidney transplant when the first has already been divided. The risk of impotence, if the second internal iliac artery is used, is greater than 25% and should be explained to the patient. This represents a very clear statement of currently accepted practice.
BACKGROUND: In 1996, a court in the United Kingdom ruled against a plaintiff who claimed that: (1) division of both internal iliac arteries at separate renal transplant operations had made him impotent and (2) the risk of his becoming impotent was sufficiently high that he should have been warned. The court ruled that there was not enough evidence in the medical literature to allow his claim to succeed. METHODS: A survey of the views of transplant surgeons in the United Kingdom and Ireland on attitudes toward using the internal iliac artery for transplantation was conducted. RESULTS: A 100% response rate was received. In a potent male patient, 11% of surgeons would never use the first internal iliac artery and 52% would use it infrequently. If one internal iliac artery had already been used, 61% would never use a second and 34% would use it infrequently. Eighty-nine percent believed the risk of impotence when the second internal iliac artery was used was 25% or higher, and 91% thought the risk should be explained to the patient. CONCLUSION: A very strong opinion exists among transplant surgeons in the United Kingdom and Ireland that the second internal iliac artery should not be used to revascularize a kidney transplant when the first has already been divided. The risk of impotence, if the second internal iliac artery is used, is greater than 25% and should be explained to the patient. This represents a very clear statement of currently accepted practice.