Document Detail


Mycotic pseudoaneurysm following a kidney transplant: a case report and review of the literature.
MedLine Citation:
PMID:  18482215     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
Vascular complications represent a significant cause of morbidity and mortality following a kidney transplant. Pseudoaneurysms are rare, occurring in approximately 1% of cases. We present a 15-yr-old patient who received a kidney transplant in the right iliac fossa. Thirty-six days following the transplant, the patient was admitted to the hospital because of a marked increase in serum creatinine levels, arterial hypertension, scrotal edema, and lower right limb pain. The patient did not present fever or raised inflammatory markers. A pseudoaneurysm was diagnosed by means of a Doppler echography and a CT. By a selective arteriography of the right iliac artery, we placed a 8 x 5 cm stent to isolate the pseudoaneurysm, due to the high risk of an extensive defect occurring in the arterial wall. Forty-eight h later the patient underwent transplant nephrectomy. Seven days following surgery, the patient experienced febrile syndrome and therefore another CT was carried out which showed a large abscess around the stent. So we decided to perform another intervention in order to drain this abscess. Due to the extensive loss of the arterial wall where the prosthesis was largely exposed, we ligated the common iliac and external iliac arteries, removed the prosthesis and performed a femoro-femoral bypass with the usual subcutaneous positioning of the prosthesis (separate from surgical site). The stent and mural thrombus were sent for culture analysis and Candida albicans was observed. The diagnosis of a pseudoaneurysm in these types of patients continues to be considered as a surgical emergency by the majority of authors. Transplantectomy is the most frequently used treatment technique. Positioning a stent prior to transplantectomy avoids ligature of the iliac artery in the majority of cases.
Authors:
Ignacio Osmán; Rafael Barrero; Eduardo León; Rafael Medina; Francisco Torrubia
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2008-05-11
Journal Detail:
Title:  Pediatric transplantation     Volume:  13     ISSN:  1399-3046     ISO Abbreviation:  Pediatr Transplant     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9802574     Medline TA:  Pediatr Transplant     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  615-9     Citation Subset:  IM    
Affiliation:
Urology, Hospitales Universitarios Virgen del Rocio, Av. Manuel Siurot S/N, Spain. nachosman79@hotmail.com
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