Iliac Artery Pseudoaneurysm Following Renal Transplantation Presenting as Lumbosacral Plexopathy

Abstract

A renal transplant patient developed chronic and progressive back and lower extremity pain followed by foot weakness. The correct diagnosis of lumbosacral plexopathy was made after electromyography and nerve conduction studies and the etiology of radiculopathy due to nerve root compression was excluded. This prompted further investigations that led to the discovery of a large internal iliac artery pseudoaneurysm. We emphasize the use of electrodiagnostic studies to investigate patients with back and limb pain for correctly localizing responsible pathology. In this case a potentially lethal situation was correctly identified in a transplant patient.

Radiculopathy Caused by Internal Iliac Artery Pseudoaneurysm Managed with Endovascular Embolization

“…The various iatrogenic causes of pseudoaneurysm or arteriovenous fistulas in the pelvis were also reported, such as transvaginal needle biopsy 15) , renal transplantation 6,8,14) , lumbar disc surgery 9) , and radiation therapy 4,18) like current case. The vascular lesion in the deep pelvic cavity could present radiating pain and motor weakness mimicking symptoms of herniation of lumbar disc or spinal cord tumor.…”

Psuedo-aneurysm following Renal Transplantation Presenting as Extensive Ileofemoral Thrombosis

“…Intrarenal pseudo aneurysms are usually secondary to acute or chronic rejections, needle biopsy of the graft kidney, whereas extra renal pseudo aneurysm have been attributed to the infection or vascular anastomotic defects [9]. When located at the anastomotic site pseudo aneurysms are commonly due to suture rupture, anastomotic leakage or vessel wall ischemia [10].…”

Transplant Renal Artery False Aneurysm: Case Report and Literature Review

“…13,14,15,16 Intra-renal false aneurysm can occur at the arcuate arteries following needle biopsy or as a result of mycotic infection. 17,18 There are no experimental or clinical data to suggest an immunological cause for extra-renal false aneurysms in transplant patients, while there are few reported cases of intra-renal small false aneurysms in association with immunologic factors such as acute or chronic rejection. Due to the small number of reported cases, immunologic factors as a pathophysiology for formation of false aneurysms in transplant patients remains as a hypothesis which needs to be proven.…”