Late complications of pancreas transplant

Endovascular management of giant common iliac artery pseudoaneurysm after complications in simultaneous pancreas–kidney transplant: a case report

“…Pseudoaneurysms at the anastomosis site are rare but potentially life-threatening conditions and may have multifactorial etiologies such as surgical technique, infection, bile leakage, or pancreatic enzymes [ 3 ]. The reported incidence of pseudoaneurysm in pancreatic transplantation, 8%, is higher than those of liver and kidney transplantation (5% and 1%, respectively), and pseudoaneurysms may occur because of laceration or disruption of the arterial wall caused by chemical damage due to exposure to enzymes during pancreatic fistula formation or the development of pancreatic infection, peripancreatic collection, chronic rejection, surgical trauma, or biopsy [ 1 , 5 , 6 ]. Pseudoaneurysms can be related to arterial anastomosis or nonanastomosis, with the former being the most frequent, whereas pseudoaneurysms caused by biopsies usually occur in the pancreatic parenchyma and can lead to arteriovenous fistulas [ 5 ].…”

“…The reported incidence of pseudoaneurysm in pancreatic transplantation, 8%, is higher than those of liver and kidney transplantation (5% and 1%, respectively), and pseudoaneurysms may occur because of laceration or disruption of the arterial wall caused by chemical damage due to exposure to enzymes during pancreatic fistula formation or the development of pancreatic infection, peripancreatic collection, chronic rejection, surgical trauma, or biopsy [ 1 , 5 , 6 ]. Pseudoaneurysms can be related to arterial anastomosis or nonanastomosis, with the former being the most frequent, whereas pseudoaneurysms caused by biopsies usually occur in the pancreatic parenchyma and can lead to arteriovenous fistulas [ 5 ]. In our case, the possible causes of pseudoaneurysm formation included multiple previous graft surgeries, remnants of the pancreatic parenchyma releasing proteolytic enzymes, fragility of the vascular anastomoses, friable tissues, and impaired hemostasis.…”

“…The clinical presentation of pseudoaneurysms is highly variable, ranging from asymptomatic cases detected on follow-up imaging to the appearance of symptoms such as abdominal pain, endocrine insufficiency, hematuria, palpable and pulsatile masses, hemodynamic instability, and sepsis. They may present as late bleeding, first with mild digestive hemorrhages, called sentinel bleeding, and evolve to an arteriovenous or arterioenteric fistula and eventually to a fatal hemorrhage [ 5 ]. Graft control with Doppler ultrasonography at follow-up is important for identifying possible asymptomatic cases [ 5 , 7 ].…”

“…They may present as late bleeding, first with mild digestive hemorrhages, called sentinel bleeding, and evolve to an arteriovenous or arterioenteric fistula and eventually to a fatal hemorrhage [ 5 ]. Graft control with Doppler ultrasonography at follow-up is important for identifying possible asymptomatic cases [ 5 , 7 ].…”

“…With Doppler ultrasound, pseudoaneurysms are identified as blood-filled lesions; direct communication with the feeding vessel may also be identified, and pulsed-wave Doppler ultrasound may show a “to-and-fro” waveform at the pseudoaneurysm neck. Computed tomography or magnetic resonance imaging is important for diagnosing other complications and planning the proper treatment strategy [ 5 ]. Digital subtraction angiography is reserved for cases in which endovascular therapy is chosen.…”