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

Abstract

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.

Significant arterial complications after pancreas transplantation—A single‐center experience and review of literature

“…The literature reporting arterial complications associated with a pancreatic allograft is sporadic, spanning 1989‐2017. In all, 7 case series and 34 case reports describe 70 patients with arterial complications. As in our series, the majority of complications were in primary pancreatic transplant recipients with enteric drainage.…”

Late recurrent bleeding episodes from duodenojejunostomy after pancreas transplantation

“…Due to the fact that follow‐up visits are not solely performed at a single center, these data likely underestimate the occurrence of late complications. Late bleeding episodes are mainly caused by the herein described late hemorrhage from the enteric graft site, by fistulae (arterioenteric, arterioureteric, arteriocystic, or arteriovenous), pseudoaneurysms, rejection, or invasive infections …”

Late complications of pancreas transplant

“…But if an arteriovenous fistula exists, embolization with microparticles is the treatment of choice[ 39 ]. These procedures can be either a definitive treatment[ 40 ] or a bridge therapy to posterior open repair[ 41 , 42 ], since rebleeding or necrosis and posterior loss of graft function are not uncommon. For this reason, on many occasions (especially in infections) allograft transplantectomy including the graft vascular anastomosis is performed, requiring sometimes an extra anatomic bypass to maintain blood flow of the lower limb[ 43 ].…”