Endovascular Interventions in Vascular Complications After Simultaneous Pancreas and Kidney Transplantations: A Single-Center Experience

Abstract

Background Vascular failures are serious complications in pancreas transplantation. Open surgery is a reliable and quick intervention method, but it carries a risk of infection and bleeding. Endovascular procedures are rare among patients after a SPK, but are becoming more frequently used. One of the main risks of the endovascular approach is that the renal function impairment caused by contrast agent. Material/Methods We performed a retrospective analysis of 200 transplanted pancreases at our center over the last 14 years. The analyses included those patients after pancreas transplantation who required the most challenging vascular interventions and ones that were non-standard for the procedure. Results Severe vascular conditions requiring endovascular intervention were observed in 3% of SPKs. In one retransplanted patient, there was an acute ischemia of the lower extremity due to the narrowing of the common iliac artery following a previous transplantectomy, above the new pancreas graft anastomoses. In another patient, local inflammation led to the disruption of the external iliac artery on the level of transplantectomy, caused severe bleeding, and we had to implement a stent-graft to reconstruct the iliac artery wall. A third patient had a pseudoaneurysm demanding further treatment with a stent-graft implemented into the femoral artery due to a pseudoaneurysm of the right external iliac artery. Conclusions Intravenous interventions in patients with a transplanted or retransplanted pancreas are safe and feasible. It is a technically demanding procedure, but the risk of kidney graft function deterioration, as well as of bleeding due to the high dose of heparin used, is lower than with open vascular surgery.

Long‐term Lower Extremity and Cardiovascular Complications after Simultaneous Pancreas‐Kidney Transplant

“…Risk factors for amputation after SPK in the MacCraith study included coronary disease 1 . Most recently in 2019, investigators from a single center in Poland published a report of endovascular interventions following pancreas transplantation; among 200 patients, endovascular intervention was required in 3% 3 …”

“…In addition to pancreatic insufficiency and ESRD, patients with type 1 DM are also at high risk of lower extremity (LE) peripheral artery disease (PAD), both before and after transplant 1 . The development of PAD is a significant source of morbidity for SPK recipients 1‐4 . One of the earliest studies examining this phenomenon was published in 2003; in a cohort of 200 SPK recipients with type 1 DM, the authors reported an amputation incidence of 6.5% prior to SPK compared with 9.5% after SPK and identified pre‐transplant amputation and duration of dialysis as significant risk factors associated with post‐transplant amputation 4 …”

“…Since then, studies have shown that the development of vascular disease following SPK is not only limb‐threatening, 1‐4 but also life‐threatening 5 . A 2004 Swedish study of 87 SPK patients suggested that the long‐term risk of myocardial infarction or stroke may be as high as 29.9% 5 .…”

Methods of arterial reconstruction for pancreatic graft

“…Еще в одном случае у пациента с повторной трансплантацией в раннем послеоперационном периоде был выявлен стеноз общей подвздошной артерии проксимальнее анастомоза, в связи с чем было выполнено эндоваскулярное стентирование артерии. При контрольном исследовании повторного стеноза выявлено не было [8].…”

Late complications of pancreas transplant

“…Although there is still a lack of reliable data due to the relatively little experience of this approach in pancreas transplant complications, endovascular procedures are becoming more frequently used as they are safe and feasible, but technically demanding. One of the main risks of this approach is the renal function damage caused by contrast agent, but the risk of kidney graft function deterioration, as well as of bleeding due to the high dose of heparin used, seems to be lower than with open surgery[ 36 ].…”