External iliac artery pseudoaneurysm complicating renal transplantation

• Published in: Interactive cardiovascular and thoracic surgery Vol. 8; no. 6; pp. 654 - 660
• Main Authors: Bracale, Umberto M, Carbone, Francesca, del Guercio, Luca, Viola, Daniela, D'Armiento, Francesco P, Maurea, Simone, Porcellini, Massimo, Bracale, Giancarlo
• Format: Journal Article
• Language: English
• Published: England Eur Assoc Cardio Surg 01.06.2009
• Subjects: Adult; Aged; Anastomosis, Surgical - adverse effects; Aneurysm, False - etiology; Aneurysm, False - microbiology; Aneurysm, False - mortality; Aneurysm, False - pathology; Aneurysm, False - surgery; Candida albicans - isolation & purification; Escherichia coli - isolation & purification; Female; Humans; Iliac Artery - microbiology; Iliac Artery - pathology; Iliac Artery - surgery; Kidney Transplantation - adverse effects; Kidney Transplantation - mortality; Magnetic Resonance Angiography; Male; Middle Aged; Nephrectomy; Renal Artery - surgery; Reoperation; Retrospective Studies; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vascular Surgical Procedures
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1510/icvts.2008.200386

a Department of Vascular and Endovascular Surgery, University Federico II, via Pansini 5, 80131 Naples, Italy b Department of Pathology, University Federico II, Naples, Italy c Department of Radiology, University Federico II, Naples, Italy *Corresponding author. Tel.: +39(0)817462629; fax: +39(0)817464732. E-mail address : palumbe{at}tin.it (U.M. Bracale). Objective: To assess the etiology, management and outcome of iliac pseudoaneurysms following renal transplantation. Methods: Eleven patients who underwent repair between 1982 and 2007 were identified. Five (Group 1) presented pseudoaneurysm at the anastomosis of the donor renal and native iliac arteries, and six (Group 2) presented iliac pseudoaneurysm following transplant nephrectomy. Intraoperative cultures and immunohistochemical examinations were obtained from all surgical cases to determine the existence of a relationship between infection or transplant rejection and pseudoaneurysm formation. Results: Endovascular repair (EVR) was used to treat three patients, while eight patients underwent open repair (OR). Transplant nephrectomy was needed in all cases but one after anastomotic pseudoaneurysm repair. After pseudoaneurysm excision, arterial reconstruction was performed in all cases, with a limb salvage rate of 100%. At 30 days, no patients died in the EVR subgroup. In the OR subgroup, one patient died of sepsis (12.5%). Cultures taken from the pseudoaneurysm wall and content grew Candida albicans and E. coli in two febrile patients. Pathologic evaluation of donor renal arteries revealed evidence of chronic rejection in three patients (60%) in Group 1, and in two (33.3%) in Group 2. No patients in either Group presented late infection, failure of vascular reconstruction nor pseudoaneurysm recurrence. The follow-up ranges from 20 to 89 months. Conclusions: The etiology of pseudoaneurysms in this location is multifactorial, however, an association with chronic rejection must be considered. Though rare, the development of pseudoaneurysms at the donor renal-external iliac artery anastomosis results in high rates of transplant nephrectomy. Less invasive endovascular techniques offer a new therapeutic option in this challenging scenario notwithstanding the fact that they require further validation. Key Words: Iliac artery; Pseudoaneurysm; Renal allograft; Endovascular repair; Open repair