To review the most recent research on difficult vascular situations involving the graft in the context of kidney transplantation, particularly during the harvesting process and back-table preparation for the eventual implant. Multiple vessels, renal artery aneurysms, kidney anatomical defects, or serious injuries that damage the kidney graft did not rule out the transplant, but they did necessitate a thorough graft viability assessment and a variety of bench surgical approaches. In the back-table, graft vessel conditioning comprised simple anastomosis, venous patch enlargement, or donor or synthetic graft repair. Literature showed a significantly longer warm ischemia duration (40 vs 32 min) and slightly higher rates of delayed graft function (10.3% vs 8.2%) and vascular problems (10.8% vs 8.1%) compared to traditional transplant, but equivalent graft and patient survival.

Extensive evaluation, precise harvesting, competent surgical technique on the bench table, and effective surgery in the recipient are all required in vascular difficult kidney graft situations. Despite its complexity, vascular complicated kidney transplants have similar long-term results to conventional kidney transplants when performed correctly, with a slightly higher incidence of vascular complications and delayed graft function.