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Hennawy HME, Al-Qahtani S, Faifi ASA, Ghalyoob TM, Khalil HF, Bazeed MF, Atta EA, Safar O, Awad A, Nazer WE, Abdelaziz AA, Mahedy A, Mirza N, Fageeh AA, Elgamal GA, Zaitoun MF, Haddad AE. Successful Endovascular Repair of Infectious External Iliac Artery Anastomotic Pseudoaneurysm With Graft Preservation Post-Kidney Transplantation: Case Report and Review of Literature. Transplant Proc 2022; 54:2709-2715. [PMID: 36786541 DOI: 10.1016/j.transproceed.2022.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/02/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Allograft artery-infected pseudoaneurysm (PA) represents a rare but life-threatening complication of kidney transplantation (KT). A review of the literature, showed that nearly all these cases ended resulted in graft loss. We presented a case of post-KT-infected external iliac artery anastomotic PA successfully managed by endovascular stenting with graft preservation. Additionally, we reviewed the pertinent literature. METHOD In this article, we described a hypertensive, 47-year-old man who presented 1 month post-cadaveric KT with acute kidney injury and gram-negative bacteremia secondary to a large infectious anastomotic PA of the external iliac artery. RESULTS Because of favorable anatomy, successful arterial angio-stent fixation of the main renal artery PA, sparing the lower polar artery, was performed after 1 week of antibiotic and fungal coverage. CONCLUSION Patient was discharged after 2 weeks with functioning graft. Graft function was stable after 3 months.
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Affiliation(s)
- Hany M El Hennawy
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia.
| | - Saad Al-Qahtani
- Radiology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Abdullah S Al Faifi
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Tayseer M Ghalyoob
- Radiology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Haytham Fouad Khalil
- Radiology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia; Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Kasr Al-Ainy St., Egypt
| | - Mohammed F Bazeed
- Radiology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Eisa Al Atta
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Omar Safar
- Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Ahmed Awad
- Vascular Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Weam El Nazer
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Abdelaziz A Abdelaziz
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Ahmed Mahedy
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Naveed Mirza
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Ali Al Fageeh
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Galal A Elgamal
- Anesthesia Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, KSA; Anesthesia Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammad F Zaitoun
- Pharmacy Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Ahmed El Haddad
- Radiology Department, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia; Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Management of Transplant Renal Artery Pseudoaneurysm and Literature Review. Case Rep Transplant 2022; 2022:6232586. [PMID: 35726284 PMCID: PMC9206571 DOI: 10.1155/2022/6232586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/25/2022] [Indexed: 11/29/2022] Open
Abstract
Renal transplantation is the ultimate treatment for end-stage renal disease patients. However, vascular complications can impact renal allograft outcomes. Extrarenal pseudoaneurysms (EPSA) are a rare complication occurring in 1% of transplant recipients. We report a case series of extrarenal pseudoaneurysm after kidney transplant with different clinical presentations and management strategies. Given the rarity of EPSA, literature describing this complication is limited to single case reports or small retrospective case series. We also provide an up-to-date review of 76 articles on mycotic, bacterial, and idiopathic EPSAs. Allograft removal is considered standard treatment, but new endovascular alternatives may allow allograft salvage. EPSA should be managed with a multidisciplinary approach. Surveillance with renal ultrasound is recommended in patients considered high risk.
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