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Fibromuscular dysplasia (FMD) of the donor renal artery may be encountered by transplant surgeons during kidney transplantation. Renal artery reconstruction prior to transplantation is indicated to reduce the risk of renovascular hypertension and ischemic nephropathy. The authors report a patient who underwent living donor (LD) transplantation of a kidney with FMD, where the artery was reconstructed with an internal iliac artery interposition graft harvested from the recipient. They conclude that this is a safe procedure that results in a satisfactory outcome. Additionally, there may be a reduced risk of progressive renovascular hypertension in the donor by eliminating FMD.

A patient with end-stage renal disease treated with peritoneal dialysis had two old, thrombosed hemodialysis access grafts in her upper limb. She presented with the puzzling problem of a slowly recurring hematoma over the venous anastomo sis of the upper arm graft . When the hematoma was explored surgically, its source was not immediately apparent; however, when the arterial anastomosis of the upper arm graft was subsequently explored, a small anastomotic pseudoaneurysm was encountered. Blood from the pseudoaneurysm had been dissecting between the graft and its fibrous tunnel and slowly accumulating at the venous anastomosis. Pseudoaneurysms occur in less than 5% of dialysis access grafts. They almost invariably present as a pulsatile hematoma over the arterial anastomosis or over a needle hole in a patent graft. The case described herein is interesting because of its unique presentation.