Treatment of transplant renal artery pseudoaneurysm using expandable hydrogel coils: A case report and review of literature

Life-Threatening Hematuria as Initial Presentation of a Complicated Transplant Renal Artery Pseudoaneurysm

In this case report, we describe the clinical course of a complicated transplant renal artery (TRA) pseudoaneurysm, clinically featured by gross and massive hematuria one month after a kidney transplant was performed on a 50 year-old male patient. TRA pseudoaneurysm is a rare but potentially life-threatening complication that may result in bleeding, infection, graft dysfunction/loss, lower limb ischemia/loss, hemorrhagic shock, and death. TRA pseudoaneurysm treatment remains challenging as it needs to be tailored to the patient characteristics including hemodynamic stability, graft function, anatomy, presentation, and pseudoaneurysm features. This publication discusses the clinical scenario of massive gross hematuria that derived from a retroperitoneal hematoma which originated from an actively bleeding TRA pseudoaneurysm. This case highlights the combined approach of endovascular stent placement and subsequent transplant nephrectomy as a last resort in the management of intractable bleeding from a complicated TRA pseudoaneurysm. To the best of our knowledge, this is the first published case report of an actively bleeding TRA anastomotic pseudoaneurysm that caused a massive retroperitoneal bleed that in turn evacuated via the bladder after disrupting the ureter-to-bladder anastomosis. A temporizing hemostatic arterial stent placed percutaneously allowed for a safer and controlled emergency transplant nephrectomy.

Transplant Renal Interventions

Renal transplantation is the most commonly performed solid-organ allograft surgery; in 2021, 25487 kidneys were transplanted in the United States, and nearly 42,000 adult patients were listed for transplant. As the treatment of choice for patients with end-stage renal disease, transplantation is performed at more than 250 centers. Despite a high rate of success, renal transplantation is not without complication, and the interventional radiologist plays a crucial role in the management of the postoperative patient. Knowledge of postsurgical anatomy, imaging findings, and technical challenges unique to these patients is important for the safe and effective treatment of transplant-related conditions. We offer a guide to the most common interventions in the renal transplant population, including biopsy, vascular interventions, and the management of urinary obstruction.

Successful Endovascular Repair of Infectious External Iliac Artery Anastomotic Pseudoaneurysm With Graft Preservation Post-Kidney Transplantation: Case Report and Review of Literature

BACKGROUND

Allograft artery-infected pseudoaneurysm (PA) represents a rare but life-threatening complication of kidney transplantation (KT). A review of the literature, showed that nearly all these cases ended resulted in graft loss. We presented a case of post-KT-infected external iliac artery anastomotic PA successfully managed by endovascular stenting with graft preservation. Additionally, we reviewed the pertinent literature.

METHOD

In this article, we described a hypertensive, 47-year-old man who presented 1 month post-cadaveric KT with acute kidney injury and gram-negative bacteremia secondary to a large infectious anastomotic PA of the external iliac artery.

RESULTS

Because of favorable anatomy, successful arterial angio-stent fixation of the main renal artery PA, sparing the lower polar artery, was performed after 1 week of antibiotic and fungal coverage.

CONCLUSION

Patient was discharged after 2 weeks with functioning graft. Graft function was stable after 3 months.

Sonographic Assessment of Renal Transplant Anastomotic Pseudoaneurysm: A Case Study

Renal transplant anastomotic pseudoaneurysms (RTAPs) are a rare vascular postoperative complication. The etiology of these pseudoaneurysms is attributed to infection or surgical vessel damage. RTAPs can lead to allograft dysfunction, allograft loss, or patient mortality due to rupture or sepsis. Because of these serious complications, expedient diagnosis is imperative for initiating surgical intervention and medical management. Sonography is a useful imaging modality for diagnosing and characterizing RTAPs. The sonographic findings, although not often described in detail in the literature, are definitive and unique. This case report describes the sonographic findings of a patient 22 days post renal autotransplant, who presented with excruciating abdominal pain. Sonographic examination identified multiple classic pseudoaneurysm findings and demonstrated intrarenal and extrarenal vascular abnormalities.