Arterial anastomosis disrupton in two kidney recipients of contaminated grafts from a donor with Gorham's syndrome

Vascular complications represent a significant cause of morbidity and mortality following a kidney transplant. Pseudoaneurysms are rare, occurring in approximately 1% of cases. We present a 15-yr-old patient who received a kidney transplant in the right iliac fossa. Thirty-six days following the transplant, the patient was admitted to the hospital because of a marked increase in serum creatinine levels, arterial hypertension, scrotal edema, and lower right limb pain. The patient did not present fever or raised inflammatory markers. A pseudoaneurysm was diagnosed by means of a Doppler echography and a CT. By a selective arteriography of the right iliac artery, we placed a 8 x 5 cm stent to isolate the pseudoaneurysm, due to the high risk of an extensive defect occurring in the arterial wall. Forty-eight h later the patient underwent transplant nephrectomy. Seven days following surgery, the patient experienced febrile syndrome and therefore another CT was carried out which showed a large abscess around the stent. So we decided to perform another intervention in order to drain this abscess. Due to the extensive loss of the arterial wall where the prosthesis was largely exposed, we ligated the common iliac and external iliac arteries, removed the prosthesis and performed a femoro-femoral bypass with the usual subcutaneous positioning of the prosthesis (separate from surgical site). The stent and mural thrombus were sent for culture analysis and Candida albicans was observed. The diagnosis of a pseudoaneurysm in these types of patients continues to be considered as a surgical emergency by the majority of authors. Transplantectomy is the most frequently used treatment technique. Positioning a stent prior to transplantectomy avoids ligature of the iliac artery in the majority of cases.

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“…There are some publications (10, 13) where the absence of fever does not exclude a mycotic pseudoaneurysm, as it occurs in our case. Zavos et al.…”

Section: Discussionmentioning

confidence: 59%

“…Contamination of the graft has been recorded in between 2.1 and 23.7% of cases (10). Contamination can occur in: the donor, during extraction, during the implant or after surgery (11).…”

Section: Discussionmentioning

confidence: 99%

Mycotic pseudoaneurysm following a kidney transplant: A case report and review of the literature

Osmán

Barrero

León

et al. 2009

Pediatric Transplantation

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“…A literature review is summarized in Table , showing the reported clinical presentations, pathogen isolates, treatment, and graft and patient survival . Severe bleeding is, unfortunately, not uncommon, and is accompanied by allograft loss in virtually all cases, with a high mortality rate .…”

Section: Discussionmentioning

confidence: 99%

Presentation and management of mycotic pseudoaneurysm after kidney transplantation

Patrono

Verhelst

Buemi

et al. 2015

Transplant Infectious Dis

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Pseudoaneurysms (PAs) developing at the site of vascular anastomosis after organ transplantation are a rare but serious complication. We report a series of 3 cases of PA observed in a single center over a period of 18 years. The mode of presentation was acute bleeding in 2 cases. In the third patient, who underwent combined kidney and pancreas transplantation, the PA on the renal graft was discovered by chance. Graft removal associated with iliac artery ligation and extra-anatomic femoro-femoral bypass represents the standard treatment. However, interposition of a venous homograft may allow preservation of inferior limb perfusion and possibly graft salvage.

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“…The presence or suspicion of sepsis with pseudoaneurysm formation makes the management somewhat more complicated. The significant benefit of open surgery in these circumstances is that debridement and washout can be performed before definitive aneurysm repair [5,6]. Although endovascular repair using prosthetic stent grafts have been described in the literature for treatment of pseudoaneurysms associated with infection it should be avoided where possible [19].…”

Section: Discussionmentioning

confidence: 99%

“…Rupture of the aneurysm can lead to life threatening haemorrhage. Treatment options include open repair [5,6], endovascular repair and percutaneous thrombin injection [7]. We report a series of six cases (1 bilateral, 4 unilateral) presenting with this rare complication that were all successfully treated by endovascular repair.…”

Section: Introductionmentioning

confidence: 99%

Endovascular Repair of Late Onset Anastomosis Site Pseudoaneurysms Complicating Renal Transplantation

MRCS¹

2014

J Vasc Med Surg

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Introduction: Extra-renal anastomosis site pseudoaneurysms are a rare complication that can occur following renal transplantation. Expansion and rupture can lead to life threatening haemorrhage. Definitive treatment options include surgical and endovascular repair. Endovascular repair has shown early promise in management and benefits from being minimally invasive. We report five patients treated with endovascular repair and discuss the factors that need to be considered to tailor individual endovascular treatment strategies. Methods: Retrospective review of late onset cases of extra-renal pseudoaneurysms managed with endovascular repair at our institutions. Case histories, mode of presentation, imaging, endovascular technique and follow up were analysed. The location, size and configuration of the pseudoaneurysm and the likely underlying aetiology are studied. Results: Between 2008 and 2013, five patients with six extra-renal pseudoaneurysms were identified. Three of these patients were on warfarin at the time of presentation. Technical success was 100% (6/6) following endovascular repair, with no significant procedure related complications. 5/6 (83%) required one procedure and 1/6 (17%) required three procedures. No recurrence demonstrated on clinical and imaging follow up. Conclusions: Endovascular repair is safe and effective in treatment of anastomosis site pseudoaneurysms and results in durable mid-term outcome.

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Arterial anastomosis disrupton in two kidney recipients of contaminated grafts from a donor with Gorham's syndrome

Cited by 8 publications

References 12 publications

Mycotic pseudoaneurysm following a kidney transplant: A case report and review of the literature

Mycotic pseudoaneurysm following a kidney transplant: A case report and review of the literature

Presentation and management of mycotic pseudoaneurysm after kidney transplantation

Endovascular Repair of Late Onset Anastomosis Site Pseudoaneurysms Complicating Renal Transplantation

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