Pseudoaneurysm of the Superior Mesenteric Artery After Pancreas Transplantation Treated by Endovascular Stenting

Abstract

Pseudoaneurysm after pancreas transplantation can have serious consequences, including rupture, hemorrhage, and graft loss. We describe a 38-year-old patient who presented with a pseudoaneurysm of the donor superior mesenteric artery 1 month after pancreas transplantation. Selective arteriography was performed and the lesion was repaired with endovascular placement of a 28-mm covered stent. Laparotomy was avoided. The pancreatic graft was continuing to function well 9 months later. As far as we know, this minimally invasive approach was not previously reported. According to published series, pseudoaneurysms often occur secondary to infection and require operative intervention necessitating graft pancreatectomy. Patients can present with serious symptoms including hypotension and shock. Therefore, it is important to detect pseudoaneurysm in a timely manner. Computed tomography and Doppler ultrasound are important diagnostic tools in this regard. We demonstrated the utility of endovascular stenting in the treatment of pseudoaneurysm after pancreas transplantation. When used in a timely manner in well selected patients, endovascular stenting can abrogate the need for operative intervention and its attendant morbidity.

Vascular catastrophes following pancreas transplantation: an evolution in strategy at a single center

“…Among the most devastating and potentially graft and life threatening of these complications are those involving the arterial vascular anastomosis. To date, there have been individual reports of arterial pseudoaneurysms (PA) (9–11), mycotic aneurysms (12), and arteriovesical (13–15) and arterioenteric (16–21) arterial fistulae. A variety of approaches to these situations have been described, most commonly involving a direct operative approach with either repair of the vascular anomaly or urgent allograft pancreatectomy and endovascular approaches such as stenting or coil embolization.…”

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

“…Surgical repair was chosen as the primary intervention for 10 complications in 9 patients, often involving allograft pancreatectomy with arterial reconstruction in the form of either primary repair, interposition, or extra‐anatomic bypass graft placement. Pseudoaneurysms were more likely to require surgical repair, but we have employed stent grafting successfully (Figure ) as has been first reported by Tan in 2001 . Six of these 9 patients (67%) had failed grafts at the time of the complication, the remaining 3 experienced graft failure as part of managing the complication.…”

“…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.…”

Value of magnetic resonance imaging in evaluating the pancreatic allograft transplant complications

“…Infection may occur in 50% patients of pancreatic allografts [24,25]. Pseudoaneurysm is associated with a risk of hemorrhage and a higher incidence of graft loss [26][27][28][29][30]. Pseudoaneurysms typically develop in the early post-operative period as either a technical complication or as a result of infection or abscess adjacent to the arterial anastomosis.…”