Mycotic pseudoaneurysm following a kidney transplant: A case report and review of the literature

Abstract

Vascular complications represent a significant cause of morbidity and mortality following a kidney transplant. Pseudoaneurysms are rare, occurring in approximately 1% of cases. We present a 15-yr-old patient who received a kidney transplant in the right iliac fossa. Thirty-six days following the transplant, the patient was admitted to the hospital because of a marked increase in serum creatinine levels, arterial hypertension, scrotal edema, and lower right limb pain. The patient did not present fever or raised inflammatory markers. A pseudoaneurysm was diagnosed by means of a Doppler echography and a CT. By a selective arteriography of the right iliac artery, we placed a 8 x 5 cm stent to isolate the pseudoaneurysm, due to the high risk of an extensive defect occurring in the arterial wall. Forty-eight h later the patient underwent transplant nephrectomy. Seven days following surgery, the patient experienced febrile syndrome and therefore another CT was carried out which showed a large abscess around the stent. So we decided to perform another intervention in order to drain this abscess. Due to the extensive loss of the arterial wall where the prosthesis was largely exposed, we ligated the common iliac and external iliac arteries, removed the prosthesis and performed a femoro-femoral bypass with the usual subcutaneous positioning of the prosthesis (separate from surgical site). The stent and mural thrombus were sent for culture analysis and Candida albicans was observed. The diagnosis of a pseudoaneurysm in these types of patients continues to be considered as a surgical emergency by the majority of authors. Transplantectomy is the most frequently used treatment technique. Positioning a stent prior to transplantectomy avoids ligature of the iliac artery in the majority of cases.

Mycotic Aneurism in Renal Transplantation Associated to Persistent Leucopenia. Case Report and Review of the Literature

“…The pain occurs in up to 76% of cases and is related to its location and the speed growth [9,10]. Rupture is reported in 45% and fistula formation only in 18% of cases; the 30-day mortality reported in Lopes, et al series was 36%, associated to rupture and fulminant sepsis [1].…”

“…considering for gram positive coverage as these are the agents that have been mostly isolated. The fungal infections occur only in 1% of cases, anywise this cause should be suspected in the presence of inmunosupresión [10].…”

Infectious anastomotic pseudoaneurysm complicating renal allograft: case report and review of literature

“…8 Osmán et al attempted endovascular stenting prior to nephrectomy to avoid the ligature of iliac artery, but it was complicated with large abscess around the stent with large vascular defect, eventually necessitating ligation of the common and external iliac arteries and femoral-femoral bypass. 10 Nevertheless, contaminated preservation solution in the process of graft handling have been reported. 6 Evidence of chronic rejection in histopathologic examination was also shown in up to 60% of infectious pseudoaneurysms in a case series.…”

“…Although the gold-standard surgical treatment of infectious anastomotic pseudoaneurysms of renal allograft artery involves graft nephrectomy and resection of pseudoaneurysm with vascular reconstruction, 4,9 endovascular means could be used in selected cases when the risk of extensive arterial wall defect is not high. 10 Smeds et al made a successful attempt in excluding a noninfectious anastomotic pseudoaneurysm using a kissing covered stent, with successful preservation of the arterial blood flow to the graft kidney and good stent patency in 1-month surveillance CT angiography. 11 Most series had shown the graft nephrectomy was inevitable, especially if the anastomosis had disintegrated as in our case.…”

Pseudoaneurysm with Candidal Infection after Renal Transplantation

“…Vascular complications are a significant cause of morbidity following a kidney transplant (1). Pseudoaneurysm, despite its rarity, is most com-monly caused by Candida albicans and Staphylococcus aureus; however, multiple pathogens have been recorded (2).…”