Interventional Stenting for Ruptured Iliac Aneurysm Following Transplant Nephrectomy

doi:10.1016/j.transproceed.2006.01.031

Transplantation Proceedings

Volume 38, Issue 3, April 2006, Pages 718-720

https://doi.org/10.1016/j.transproceed.2006.01.031 Get rights and content

Abstract

Surgical removal of a failed kidney graft may lead to a variety of postoperative complications, development of an aneurysm being a relatively rare complication. We report the case of a 34-year-old man who developed an iliac aneurysm 13 years after transplant nephrectomy. Interventional stenting was performed upon the rupture of the aneurysm. Postintervention the function of the contralateral transplanted kidney was stable and the patient recovered. An endoleak was diagnosed after 1 week, which was also stented. No operative procedure was necessary. In conclusion, even in an emergency situation interventional stenting of a false iliac aneurysm after transplant nephrectomy may be a therapeutic option.

Section snippets

Case

A 19-year-old patient with end-stage renal failure resulting from focal sclerosing glomerulonephritis underwent a kidney transplantation from a deceased donor after 1 year of hemodialysis. He underwent transplant nephrectomy after a complete functional loss had occurred due to chronic rejection. Five years later, he underwent a contralateral transplantation. The initial immunosuppressive regimen was cyclosporine (CsA), mycophenolate mofetil (MMF), and corticosteroids, with corticosteroids being

Discussion

False aneurysms require definitive therapy to avoid rupture. In this case, we were confronted with the “fait accompli” before the planned therapy, which followed improvement of the metabolic disorder. Although open surgical repair is the standard treatment for the rupture of an iliac aneurysm, the surgical approach can be difficult and burdened with complications. Also interventional treatment may be successful, since the anastomotic region, which is the origin for these false aneurysms, is

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Cited by (8)

Renal artery infectious (mycotic) pseudoaneurysms in renal transplantation recipients
2021, Actas Urologicas Espanolas
La infección de la arteria en el lugar de la anastomosis o a su alrededor es una complicación ominosa que se presenta comúnmente como una fuga y/o disolución local de la pared arterial.
Revisión narrativa basada en artículos relevantes indexados en PubMed, EMBASE y Scielo, escritos en inglés o español, durante el período de enero del año 2000 a diciembre de 2019. Se realizó un análisis agrupado de acuerdo con la etiología. A partir de los resultados obtenidos con este enfoque, se sugiere un algoritmo diagnóstico/terapéutico para optimizar su manejo clínico.
Los pseudoaneurismas arteriales son hematomas contenidos pseudoencapsulados generados por una fuga arterial. Son infrecuentes (< 1% de los casos), en su mayoría relacionados con una infección (contaminación del líquido de preservación o sepsis), y localizados en el sitio de anastomosis arterial en receptores de trasplante renal. Aunque con frecuencia se diagnostican en pacientes sintomáticos días/semanas después del trasplante, pueden pasar desapercibidos durante largos periodos de tiempo, siendo diagnosticados de forma incidental. La ecografía Doppler color confirma la sospecha clínica. La angioTC y la angiografía se utilizan para la planificación quirúrgica o el tratamiento endovascular, respectivamente. El diagnóstico etiológico se realiza en base al cultivo del tejido extirpado. La elección del enfoque del tratamiento se basa principalmente en la presentación clínica y la localización anatómica. Las opciones terapéuticas incluyen la inyección percutánea de trombina guiada por ecografía, el tratamiento endovascular y la cirugía.
Los pseudoaneurismas micóticos en receptores de trasplante renal pueden suponer un gran desafío en los casos de rotura espontánea, dado el riesgo de hemorragia masiva y muerte. El manejo adecuado requiere un diagnóstico preciso. La implantación temprana del stent endovascular sigue siendo el tratamiento de elección en los pacientes con inestabilidad hemodinámica. La inyección percutánea y la reconstrucción vascular presentan tasas de éxito variables en la preservación de la función del injerto.
Infection of the artery at or around the anastomotic site is an ominous complication commonly presenting as a leak and/or local dissolution of the arterial wall.
Narrative review based on relevant PubMed, EMBASE, and Scielo indexed English or Spanish-written articles for the period January 2000-December 2019. A pooled analysis regarding etiology was performed. Based on the results obtained with this approach, a diagnostic/therapeutic algorithm is suggested in order to optimize its clinical management.
Arterial pseudoaneurysms are pseudocapsuled contained hematomas generated as the result of an arterial leaking. They are infrequent(<1% of cases),mostly related with infection(contamination of preservation fluid or sepsis) and located at the arterial anastomotic site in renal transplantation recipients. Although they are frequently diagnosed in symptomatic patients days/weeks after transplantation, they may remain unnoticed for long periods being diagnosed incidentally. Color coded-Doppler ultrasound confirms the clinical suspicion. Angio CT-scan and angiography are used for surgical planning or endovascular treatment, respectively. The etiological diagnosis is made on a basis of excised tissue culture. The decision-making process regarding the treatment approach, mostly relies on clinical presentation and anatomical location. Therapeutic options include ultrasound-guided percutaneous thrombin injection, endovascular treatment, and surgery.
Mycotic pseudoaneurysms in renal transplantation recipients may pose a significant challenge in cases of spontaneous rupture, given the risk for massive bleeding and death. Adequate management requires accurate diagnosis. Early endovascular stenting remains the treatment of choice in hemodynamically unstable patients. Percutaneous injection and vascular reconstruction present variable success rates in preserving graft function.
Mycotic Pseudoaneurysm After Kidney Transplantation: Two Case Reports
2017, Transplantation Proceedings
Citation Excerpt :
In patients who have infection, stent placement is only a temporary measure until definitive treatment can be performed. The exclusion of the renal allograft by placement of an endograft on the recipient external iliac artery may be considered in emergency situations and requires transplant nephrectomy after patient stabilization [32–34]. Selective embolization may be a treatment option for arteriovenous fistulas or small pseudoaneurysms.
Vascular complications after kidney transplantation may cause allograft loss. Here, we describe 2 patients with extrarenal mycotic pseudoaneurysm after kidney transplantation.
Patient 1 was a 54-year-old man who developed pseudoaneurysm 60 days after transplantation, and patient 2 was a 48-year-old woman who was diagnosed with a pseudoaneurysm 5 months after transplantation.
Patient 1 had a deceased-donor kidney transplant with end-to-side external iliac arterial anastomosis that was reconstructed 8 days after transplantation owing to rupture and major bleeding. At 60 days after transplantation, he had high serum creatinine level and Doppler ultrasonography showed a pseudoaneurysm of the arterial graft anastomosis and postanastomotic renal artery stenosis. Treatment included surgical excision of the pseudoaneurysm, vascular reconstruction, and fluconazole, with mycologic culture of the resected pseudoaneurysm showing Candida albicans. Patient 2 developed nondisabling intermittent claudication at 5 months after kidney transplantation, with a pseudoaneurysm subsequently observed on Doppler ultrasonography and computerized tomographic angiography. Treatment included renal artery thrombectomy and common iliac bypass to the hilar donor renal artery with inverted ipsilateral long saphenous vein. Operative samples showed C albicans, and she was treated with fluconazole. Both patients had satisfactory outcomes, and both kidney allografts were preserved.
Extrarenal mycotic pseudoaneurysms after kidney transplantation require a high index of suspicion for early diagnosis, and preservation of the kidney graft may be achieved with the use of surgical treatment and antifungal therapy.
Uterine allograft removal by total laparoscopic hysterectomy after successful cesarean delivery in a living-donor uterus recipient with uterovaginal agenesis (MRKHS)
2023, Archives of Gynecology and Obstetrics
Diagnosis and Management of Transplanted Kidney Extrarenal Pseudoaneurysms: A Series of Four Cases and a Review of the Literature
2016, CardioVascular and Interventional Radiology
Iliac artery pseudoaneurysm: A rare complication following allograft nephrectomy
2014, BMJ Case Reports
Kidney post-transplantectomy ruptured iliac pseudoaneurysm: Emergency endovascular repair
2012, Nefrologia

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Kidney transplantationComplicationInterventional Stenting for Ruptured Iliac Aneurysm Following Transplant Nephrectomy

Abstract

Section snippets

Case

Discussion

J Urol

Am J Kidney Dis

Ann Vasc Surg

Surgical complications of kidney transplantation

J Nephrol

Renal transplant nephrectomy in childrencan an aggressive approach be recommended?

Pediatr Transplant

Iliac artery false aneurysm following renal allograftpresentation with non-specific inflammatory response and treatment by endovascular stent graft

Nephrol Dial Transplant

Kidney transplantation
Complication
Interventional Stenting for Ruptured Iliac Aneurysm Following Transplant Nephrectomy