Pseudoaneurysm of the Y‐graft/iliac artery anastomosis following pancreas transplantation: a case report and review of the literature

Verni, Michael; Leone, John P.; Deroover, Arnaud

doi:10.1034/j.1399-0012.2001.150113.x

Cited by 38 publications

(27 citation statements)

References 11 publications

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“…Various causes of catastrophic GI hemorrhage after pancreas transplantation include AE and AV fistulae with pseudoaneurysms, aortoenteric fistulae, and enteric anastomotic bleeding [2, 6, 8–11, 17]. AE and AV fistulae can involve the superior mesenteric artery and vein with aneurysmal dilatation and duodenum graft [12], gastroduodenal artery [18], the transplanted arterial graft and the duodenum graft [7], and the graft-recipient arterial anastomosis and stump leak [7] after pancreas kidney transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…Common vascular complications after pancreas transplantation include venous and arterial thrombosis, vascular stenosis and kinks, and arterial dissection due to either clamping injuries or native atherosclerotic disease [2]. Uncommon vascular complications after pancreas transplantation include arteriovenous (AV) fistulae and pseudoaneurysms, arterioenteric (AE) fistulae, enteric anastomotic bleeding, and mycotic pseudoaneurysms [3–10]. AE and AV fistulae after failed pancreas allograft are challenging entities for obscure GI bleeding.…”

Section: Introductionmentioning

confidence: 99%

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Arteriojejunal Fistula Presenting with Recurrent Obscure GI Hemorrhage in a Patient with a Failed Pancreas Allograft

Desai

Patel

Nwosu

et al. 2013

Case Reports in Transplantation

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We present a case of a patient with a failed pancreaticoduodenal allograft with exocrine enteric-drainage who developed catastrophic gastrointestinal (GI) hemorrhage. Over the course of a week, she presented with recurrent GI bleeds of obscure etiology. Multiple esophago-gastro-duodenoscopic (EGD) and colonoscopic evaluations failed to reveal the source of the hemorrhage. A capsule endoscopy and a technetium-labeled red blood cells (RBC) imaging study were similarly unrevealing for source of bleeding. She subsequently developed hemorrhagic shock requiring emergent superior mesenteric arteriography. Run off images revealed an external iliac artery aneurysm with fistulization into the jejunum. Coiled embolization was attempted but abandoned because of hemodynamic instability. Deployment of a covered endovascular stent into the right external iliac artery over the fistula site resulted in immediate hemodynamic stabilization. A high index of suspicion for arterioenteric fistulae is needed for diagnosis of this uncommon but eminently treatable form of GI hemorrhage in this patient population.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Arteriojejunal Fistula Presenting with Recurrent Obscure GI Hemorrhage in a Patient with a Failed Pancreas Allograft

Desai

Patel

Nwosu

et al. 2013

Case Reports in Transplantation

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“…Arterial and venous thrombosis, hemorrhages, and arteriovenous fistulae have been well described. However, few reports exist in the literature on the diagnosis and management of aneurysms associated with pancreas transplantation (Table 1) [12]. …”

Section: Discussionmentioning

confidence: 99%

Arterial Pseudoaneurysm Associated with Pancreas and Kidney Transplantation: A Case Report

et al. 2017

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Patient: Male, 49Final Diagnosis: Arterial pseudoaneurysmSymptoms: Abdominal pain • fever and a pulsatile tumor located in the right iliac fossaMedication: —Clinical Procedure: Endovascular and surgical approachSpecialty: TransplantologyObjective:Unusual clinical courseBackground:Pseudoaneurysm is a rare vascular complication in pancreas transplantation. This complication develops from a disruption of the arterial continuity, usually related to trauma, infection, vasculitis, or complications in vascular procedures.Case Report:A 43-year-old man underwent simultaneous pancreas and kidney transplantation for end-stage renal disease. He subsequently developed acute pancreatitis and acute kidney cellular rejection as late complications, thus returning to hemodialysis. A new, uneventful kidney transplantectomy and living donor kidney transplant was performed. One year after the last transplant, the patient presented with moderate abdominal pain, fever, and a pulsatile tumor located in the right iliac fossa. A pseudoaneurysm located in the pancreatic Y graft was observed. The patient was treated using an endovascular and surgical approach.Conclusions:A combined procedure using an endovascular and surgical approach promoted a good vascular control with a lower risk of bleeding in a rare case of pseudoaneurysm in a transplant patient.

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“…Successful endovascular intervention in these types of cases has been reported in various publications [6][7][8][9][10]. This modality offers a bridge to definitive treatment by allowing for temporary control of bleeding while giving time to medically optimize the patient and delineate the anatomy before surgery.…”

Section: Discussionmentioning

confidence: 99%

Arterio-colonic Fistula as a Complication of Failed Pancreatic Transplant

Mantilla¹,

Calata²,

Trepanier³

et al. 2018

Int J Surg Res Pract

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of insulin-dependent diabetes mellitus (IDDM) complicated by diabetic nephropathy and end-stage renal disease (ESRD) on hemodialysis. After a standard preoperative pre-transplant process, he was found to have a matched cadaveric donor and underwent a combined kidney and pancreas transplant. The pancreatic graft was enterically drained and the kidney was placed in the left lower abdomen in the traditional manner. The first two weeks of postoperative course were complicated by pancreatic graft thrombosis and ureteral leak, requiring pancreatectomy, right common iliac artery repair with a bovine patch, and repair of the ureteral leak with nephrostomy tube placement. After being discharged from the hospital, he had a slow recovery, requiring close monitoring and frequent follow up appointments. Fourteen months after the initial surgery, he presented to the emergency room complaining of abdominal pain after a fall. Due to concern of organ damage from blunt trauma to the abdomen, a computerized tomography scan (CT) of the abdomen and pelvis with intravenous contrast was performed which showed a pseudoaneurysm arising off the right common iliac artery with free pelvic fluid concerning for an associated leak (Figure 1). There was also demarcation of the sigmoid colon with contrast despite the lack of administration of oral contrast. No definitive fistulous tract was seen; however, an arterio-enteric fistula was highly suspected based on the history of the arterial wall patch repair. The patient remained hemodynamically stable without evidence of gastrointestinal bleeding. Vascular surgery was consult- AbstractArterio-enteric fistulas are rare but feared complications after failed enterically drained pancreatic transplants. Massive and abrupt gastrointestinal bleeding is the cardinal presentation as a result of pseudoaneurysm rupture into the bowel lumen. However, subclinical presentation of delayed arterio-enteric fistulas may represent a diagnostic challenge for surgeons and warrants a high index of suspicion. Endovascular techniques have evolved as an excellent option as a bridge to definitive treatment.

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Pseudoaneurysm of the Y‐graft/iliac artery anastomosis following pancreas transplantation: a case report and review of the literature

Cited by 38 publications

References 11 publications

Arteriojejunal Fistula Presenting with Recurrent Obscure GI Hemorrhage in a Patient with a Failed Pancreas Allograft

Arteriojejunal Fistula Presenting with Recurrent Obscure GI Hemorrhage in a Patient with a Failed Pancreas Allograft

Arterial Pseudoaneurysm Associated with Pancreas and Kidney Transplantation: A Case Report

Arterio-colonic Fistula as a Complication of Failed Pancreatic Transplant

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