title: Kidney transplantation and large anastomotic pseudoaneurysm. Transplant management considerations.
abstract: OBJECTIVE
  Pseudoaneurysm (PA) at the anastomosis site in kidney transplantation is a rare but serious complication that usually requires graft nephrectomy. Literature reports are sporadic and usually focused on limb rather than graft salvage. In this paper we focus on this last point.
  
  
  METHODS
  6 patients presenting large PA at the anastomosis between iliac and graft artery were identified in our series. The diagnosis was performed with US, AngioTC scan and angiography. Blood cultures and labeled leukocyte scintigraphy were also performed. All patients underwent open surgery.
  
  
  RESULTS
  Transplant nephrectomy was needed in all cases except one, in which it was possible to perform a graft replanting on hypogastric artery. Our perioperative mortality and morbidity rate was recorded.
  
  
  CONCLUSIONS
  Etiology of PA is multifactorial, however an association with chronic rejection or infection must be also considered. Our mortality and morbidity rates are in accordance to literature. In our experience we observed only large PA so to require an open surgery but this approach has allowed the rescue of graft functioning just in a single case. Endovascular procedures are linked to higher rate of graft salvage than surgery but they can be used just in selected cases.
  
  
  CONCLUSIONS
  Our experience and literature review led us to believe that the rate of graft salvage in patients with large PA at anastomosis site could be improved only by a planned therapeutic program that includes surgical and endovascular approach, taking the advantages of both technique and overcoming their limits.
authors.forename: Michele L
authors.initials: ML
authors.lastname: Santangelo
authors.forename: Umberto M
authors.initials: UM
authors.lastname: Bracale
authors.forename: Nicola
authors.initials: N
authors.lastname: Carlomagno
authors.forename: Davide
authors.initials: D
authors.lastname: De Rosa
authors.forename: Sergio
authors.initials: S
authors.lastname: Spiezia
authors.forename: Alessandro
authors.initials: A
authors.lastname: Scotti
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Tammaro
authors.forename: Massimo
authors.initials: M
authors.lastname: Porcellini
authors.forename: Andrea
authors.initials: A
authors.lastname: Renda
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D017541:Aneurysm, False / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000601:surgery*
keywords: Anastomotic pseudo-aneurysm, Surgical treatment, Transplantation nephrectomy, Kidney transplantation.