Successful Endovascular Management of Juxta Internal Iliac Vessel Pseudoaneurysm with Allograft Preservation in Post-Renal Transplant

Abstract

Vascular complications following renal transplant surgery are extremely uncommon, and pseudoaneurysm is even rarer, with an
incidence of 0.3%. The presentation can vary from acute blood loss to chronic dull aching pain, anorexia, etc. Majority of pseudoaneurysms are associated with allograft loss. We present a case of an anastomotic pseudoaneurysm successfully managed with
an endovascular approach. A 54-year-old female, post cadaveric renal transplant (end-to-end anastomosis between the renal artery
and right internal iliac artery) presented on post-operative day 159 with complaint of fever with chills. On treating conservatively
with antibiotics, the fever subsided, only to recur after 5-days. On further investigation, c-reactive protein (CRP) was found to be
persistently elevated. Patient’s fever of unknown origin was further investigated with repeat blood culture and fluoro-D-glucose
(FDG) positron emission tomography (PET)/computed tomography (CT). Blood culture was positive for Klebsiella pneumoniae
sensitive to colistin and tigecycline and FDG-PET showed a 5 cm aneurysm of the juxta anastomotic segment of the right internal iliac vessels, a possible pseudoaneurysm. After a multidisciplinary discussion, the patient underwent renal angiography, an
aneurysm was delineated, and a covered stent was placed which partially excluded the aneurysm. The patient responded well to
the intervention. Pseudoaneurysm formation is a rare and potentially life-threatening complication and can present even in the
late post-operative period. Endovascular management can be a safe approach in carefully selected cases with allograft preservation
being of paramount importance.