Treatment of Visceral Transplant Pseudoaneurysms Using Physician-Modified Fenestrated Stent Grafts: Initial Experience

Abstract

Pseudoaneurysms after visceral transplantation represent a significant risk to patients. We report the successful treatment of three transplant (pancreas, liver and kidney) artery anastomotic pseudoaneurysms using physician-modified fenestrated endovascular stent grafts. In all cases, surgical repair was considered high risk and would have compromised the arterial supply to the graft. The endovascular approach in all cases obviated the need for surgical intervention and maintained graft arterial supply.

Salvage of Graft Pancreas in a Simultaneous Pancreas-kidney Transplant Recipient With Splenic Artery Thrombosis, Infected Walled-off Necrosis, and Stenting of Y Arterial Graft Stenosis

“…The percutaneous endovascular intervention reported in the literature for graft salvage in TPAS or venous thrombosis or pseudoaneurysms of graft pancreas has had a limited success. 13-16…”

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

“…Vascular complications are one of the most common and feared complications of visceral transplants, requiring challenging clinical and surgical management [ 1 – 4 ]. 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 ].…”

Endovascular management of complete disruption of aortic anastomosis after pediatric multivisceral transplant

“…One group reported the use of physician-modified endografts for treatment of various visceral transplant pseudoaneurysms. 6 Here, a large aortic endograft must be carefully modified on the back table before which has been subsequently drained and found to be a fungal abscess (drain can be seen at right of image). deployment and cannulated intraoperatively to deploy a balloon-expandable endograft branch.…”

“…One group reported the use of physician-modified endografts for treatment of various visceral transplant pseudoaneurysms. 6 Here, a large aortic endograft must be carefully modified on the back table before deployment and cannulated intraoperatively to deploy a balloon-expandable endograft branch. This method is unlikely to work for a case such as ours, given the acuity of bleeding (with associated shortage of time to modify a device) and that anatomically, a long gap with a tortuous path needed to be traversed before sealing in the aortic conduit ( Fig 2 , B ).…”