Mycotic pseudoaneurysms complicating renal transplantation: a case series and review of literature

Abstract

IntroductionKidney transplantation can be complicated by infection and subsequent development of mycotic aneurysm, endangering the survival of the graft and the patient. Management of this condition in five cases is discussed, accompanied by a review of the relevant literature.Case presentationsFive patients, three men 42-, 67- and 57-years-old and two women 55- and 21-years-old (mean age of 48 years), all Caucasians, developed a mycotic aneurysm in the region of the anastomosis between renal graft artery and iliac axes. Four patients presented with systemic fever and iliac fossa pain and one presented with hemorrhagic shock. Morphologic investigation by color doppler ultrasonography revealed a pseudoaneurysm at the anastomotic site. A combination of antibiotic therapy, surgery and interventional procedures was required as all kidney transplants had to be removed. No recurrence was recorded during the follow-up period.ConclusionsA high index of suspicion is required for the timely diagnosis of a mycotic aneurysm; aggressive treatment with cover stents and/or surgical excision is necessary in order to prevent potentially fatal complications.

Mycotic Aneurism in Renal Transplantation Associated to Persistent Leucopenia. Case Report and Review of the Literature

“…Surgical management planning should include the monitoring of any distant septic source [1,12]. A treatment modality is the excision of the infectious aneurysm and placement of prosthetic material preferably medicated; another modality is the endovascular management [12].…”

“…Leonardou, et al reported a 5 case series of mycotic aneurysm in kidney transplant recipients, using a combination of antibiotic therapy, surgery and interventional procedures, with a 100% survival of the patient, but graft lost in all cases [12].…”

Infectious anastomotic pseudoaneurysm complicating renal allograft: case report and review of literature

“…While anastomotic pseudoaneurysms have been reported since 1985, 2 infectious pseudoaneurysms have been rarely reported and were often associated with graft loss in the case reports and series available in literature (Table 1). 3,4 They usually present with a wide spectrum of presentation, ranging from iliac fossa pain and fever to lower limb ischemia or even hemorrhagic shock due to rupture of pseudoaneurysm. Causes of infectious aneurysm formation are multifactorial.…”

“…7,8 Leonardou et al reported two cases with P. aeruginosa isolated from the blood culture, and both patients were treated with ciprofloxacin for 4 weeks in total after surgery. 4 No recurrence was detected up to 36 months. Unfortunately, in our patient, no single antibiotic agent was able to control the infection.…”

“…Most authors in recent literature advocated a multidisciplinary management approach 4 comprising both medical treatment with antibiotics and surgical management. Although the gold-standard surgical treatment of infectious anastomotic pseudoaneurysms of renal allograft artery involves graft nephrectomy and resection of pseudoaneurysm with vascular reconstruction, 4,9 endovascular means could be used in selected cases when the risk of extensive arterial wall defect is not high.…”