Management of Transplant Renal Artery Pseudoaneurysm and Literature Review

Abstract

Renal transplantation is the ultimate treatment for end-stage renal disease patients. However, vascular complications can impact renal allograft outcomes. Extrarenal pseudoaneurysms (EPSA) are a rare complication occurring in 1% of transplant recipients. We report a case series of extrarenal pseudoaneurysm after kidney transplant with different clinical presentations and management strategies. Given the rarity of EPSA, literature describing this complication is limited to single case reports or small retrospective case series. We also provide an up-to-date review of 76 articles on mycotic, bacterial, and idiopathic EPSAs. Allograft removal is considered standard treatment, but new endovascular alternatives may allow allograft salvage. EPSA should be managed with a multidisciplinary approach. Surveillance with renal ultrasound is recommended in patients considered high risk.

A Rare Case of Gas Forming Enterobacter cloacae Leading to Bleeding Mycotic Pseudoaneurysm of Transplant Renal Artery Culminating in Graft Nephrectomy

“…It does not contain any true vessel wall [19]. Management of mycotic PA includes observation, endovascular intervention such as thrombin injection, endovascular stenting and coiling, surgical repair and graft nephrectomy [20]. Small PA < 2 cm should be observed and may close spontaneously [21].…”

Successful repair of transplant renal artery aneurysm (TRAA)

“…A transplant nephrectomy is deemed to be the definitive treatment for post renal transplant aneurysm [ 11 ]. In cases where the graft can be preserved, endovascular stenting, percutaneous thrombin injection or open surgical repair can be considered.…”

“…Open surgical options for TRAA includes transplant nephrectomy, creation of vascular anastomoses [ 11 ], as well as traditional surgical methods like aneurysmectomy which is the most commonly described surgical method for the repair of renal artery aneurysm [ 12 ]. Aneurysectomy has not been described as a treatment for TRAA.…”