Endovascular repair of a para-anastomotic pseudoaneurysm after renal autotransplantation: an alternative to open reconstruction.
Renal artery anastomotic pseudoaneurysms are rare after renal transplantation. The etiology tends to be technical, infectious, or degenerative, and repair is difficult with a high postsurgical complication rate. We report the first case of a complex autotransplant renal artery pseudoaneurysm repaired with kissing covered stents. A 52-year-old woman presented with severe left lower quadrant abdominal pain 6 years after a renal autotransplant for ureteral stenosis and recurrent pyelonephritis. A computed tomographic angiography (CTA) scan revealed a bilobed aneurysm arising at the anastomosis between the renal and common iliac arteries. Kissing covered stents were placed within the common iliac artery proximally and extending into the transplant renal artery and external iliac artery. Postdeployment angiography confirmed complete exclusion of the pseudoaneurysm and excellent flow into the transplant kidney and left lower extremity. A follow-up CTA scan at 1 month revealed continued stent-graft patency and complete exclusion of the pseudoaneurysm. An endovascular approach to transplant anastomotic pseduoaneurysms using kissing covered stents is a viable option to exclude aneurysmal changes and preserve flow to the transplanted organ in carefully selected patients.
Department of Surgery, Division of Vascular Surgery, Saint Louis University Hospital, 3635 Vista Avenue at Grand Boulevard, St. Louis, MO 63110, USA. msmeds@slu.edu
Matthew R
MR
Smeds
Richard
R
Ofstein
Gary J
GJ
Peterson
Brian G
BG
Peterson
Donald L
DL
Jacobs
D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D003251:Constriction, Pathologic; D057510:Endovascular Procedures / Q000295:instrumentation; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000637:transplantation*; D012086:Reoperation; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous / Q000009:adverse effects; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000601:surgery*