Successful Endovascular Management of Juxta Internal Iliac Vessel Pseudoaneurysm with Allograft Preservation in Post-Renal Transplant
DOI:
https://doi.org/10.17140/NPOJ-7-127Keywords:
Endovascular; Pseudoaneurysm; Renal transplant; C-reactive protein (CRP).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.
References
Anders L, Stephens R, Laub M, Amarath-Madav R, Mirza A, Saeed MI. Management of transplant renal artery pseudoaneurysm and literature review. Case Rep Transplant. 2022; 2022: 6232586. doi: 10.1155/2022/6232586
Srivastava A, Kumar J, Sharma S, Abhishek, Ansari MS, Kapoor R. Vascular complication in live related renal transplant: An experience of 1945 cases. Indian J Urol. 2013; 29(1): 42-47. doi: 10.4103/0970-1591.109983
Chung MM, Chan YC, Law Y, Cheng SW. Infectious anastomotic pseudoaneurysm complicating renal allograft: Case report and review of literature. Int J Nephrol Renovasc Dis. 2017; 10: 55-60. doi: 10.2147/IJNRD.S122725
Al-Wahaibi KN, Aquil S, Al-Sukaiti R, Al-Riyami D, Al-Busaidi Q. Transplant renal artery false aneurysm: Case report and literature review. Oman Med J. 2010; 25(4): 306-310. doi: 10.5001/ omj.2010.88
Janho KE, Shishani JM, Habboub HK. Endovascular repair of renal artery aneurysm in a transplanted kidney. Oman Med J. 2019; 34(2): 169-171. doi: 10.5001/omj.2019.31
Bracale UM, Santangelo M, Carbone F, et al. Anastomotic pseudoaneurysm complicating renal transplantation: Treatment options. Eur J Vasc Endovasc Surg. 2010; 39(5): 565-568. doi: 10.1016/j.ejvs.2009.12.010
Cano-Velasco J, Polanco-Pujol L, Gonzalez-Garcia J, Herranz-Amo F, Hernandez-Fernandez C. Renal artery infectious (mycotic) pseudoaneurysms in renal transplantation recipients. Actas Urol Esp (Engl Ed). 2021; 45(5): 335-344. doi: 10.1016/j.acuroe.2021.04.009 Submit your article to this journal | https://openventio.org/submit-manuscript/ 7 Shah SJ, et al
Salehipour M, Salahi H, Fathikalajahi A, et al. Is perioperative intravesically applied antibiotic solution effective in the prophylaxis of urinary tract infections after renal transplantation? Urol Int. 2010; 85: 66-69. doi: 10.1159/000296303 Case Report | Volume 7 | Number 1|
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All content published in Nephrology (NOJ) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.