Arterial anastomotic pseudoaneurysms in renal transplants: Case series and a scoping review
Objective: Anastomotic pseudoaneurysms (APs) in renal transplants are rare. Definite guidelines for its management are lacking. A case series and a technique of in-vivo cooling are presented, and the literature is reviewed to help making informed decisions. Methods: This is a retrospective analysis...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-01-01
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| Series: | JVS-Vascular Insights |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2949912725000510 |
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| author | Ajay Kumar Dabas, DNB Vishal Singh, DNB Brijesh Biswas, DNB Manvendu Jha, DNB Amit Agrawal, DNB Amit Shah, DNB Puneet Aggarwal, DNB Aditya Gupta, MCh Ajay Kumar Sharma, MS, FRCS |
| author_facet | Ajay Kumar Dabas, DNB Vishal Singh, DNB Brijesh Biswas, DNB Manvendu Jha, DNB Amit Agrawal, DNB Amit Shah, DNB Puneet Aggarwal, DNB Aditya Gupta, MCh Ajay Kumar Sharma, MS, FRCS |
| author_sort | Ajay Kumar Dabas, DNB |
| collection | DOAJ |
| description | Objective: Anastomotic pseudoaneurysms (APs) in renal transplants are rare. Definite guidelines for its management are lacking. A case series and a technique of in-vivo cooling are presented, and the literature is reviewed to help making informed decisions. Methods: This is a retrospective analysis of all the patients who developed APs following renal transplants done between 2013 and 2023. PubMed and Scopus were searched for key words: pseudoaneurysm, aneurysm, arteritis, rupture, renal-transplant, allograft, kidney, mycotic, and fungal/infective. APs or bleeding from transplanted renal artery or anastomosis were included. APs secondary to transplanted renal artery stenosis, intervention, adjacent organ infection, pregnancy, intrarenal pseudoaneurysms, multiorgan transplants, unknown donor status and non-functional grafts were excluded. Results: Eight patients developed APs out of 714 transplants. The technique of in vivo cooling helped save one allograft. Six allografts were explanted. One patient died suddenly at home. After literature search, 199 cases were analyzed. One hundred sixty-four presented within 90 days of transplant (group A), 21 between 91 and 365 days (group B), and 14 after 365 days (group C). APs was evident in 111, and 88 presented with bleeding/hemorrhagic shock, including three deaths. Infective etiology was confirmed by histopathology or culture in 156 cases; Candida, Aspergillus, and Pseudomonas were the most common microbes. However, only 101 had clinical sepsis. Fifty-one had symptoms due to compression of adjacent artery/vein/nerve. Fifty-nine allografts (group A, 38; group B, 9; group C, 12) were saved out of 82 attempted. Nephrectomy with/without arterial reconstruction was done in 115, with recurrence in 26. There were 26 deaths, and all were in group A. Conclusions: APs in renal transplants though rare, result in high mortality and graft loss. Most occur within a year of transplant. Despite infective etiology, features of sepsis can be absent. Recurrence is high following salvage attempt or nephrectomy. |
| format | Article |
| id | doaj-art-760589f4797645c8be12b0fb1eefd109 |
| institution | Kabale University |
| issn | 2949-9127 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JVS-Vascular Insights |
| spelling | doaj-art-760589f4797645c8be12b0fb1eefd1092025-08-20T03:47:27ZengElsevierJVS-Vascular Insights2949-91272025-01-01310023410.1016/j.jvsvi.2025.100234Arterial anastomotic pseudoaneurysms in renal transplants: Case series and a scoping reviewAjay Kumar Dabas, DNB0Vishal Singh, DNB1Brijesh Biswas, DNB2Manvendu Jha, DNB3Amit Agrawal, DNB4Amit Shah, DNB5Puneet Aggarwal, DNB6Aditya Gupta, MCh7Ajay Kumar Sharma, MS, FRCS8Department of Vascular and Endovascular Surgery, Army Hospital Research and Referral, Delhi, India; Correspondence: Ajay Kumar Dabas, DNB, Department of Vascular and Endovascular Surgery, Army Hospital Research and Referral Delhi, Delhi 110010, IndiaDepartment of Nephrology, Army Hospital Research and Referral, Delhi, IndiaDepartment of Vascular and Endovascular Surgery, Army Hospital Research and Referral, Delhi, IndiaDepartment of Vascular and Endovascular Surgery, Army Hospital Research and Referral, Delhi, IndiaDepartment of Urology and Renal Transplant, Army Hospital Research and Referral, Delhi, IndiaDepartment of Urology and Renal Transplant, Army Hospital Research and Referral, Delhi, IndiaDepartment of Urology and Renal Transplant, Army Hospital Research and Referral, Delhi, IndiaDepartment of Vascular and Endovascular Surgery, Army Hospital Research and Referral, Delhi, IndiaTransplant Unit, Royal Liverpool University Hospital, Liverpool, EnglandObjective: Anastomotic pseudoaneurysms (APs) in renal transplants are rare. Definite guidelines for its management are lacking. A case series and a technique of in-vivo cooling are presented, and the literature is reviewed to help making informed decisions. Methods: This is a retrospective analysis of all the patients who developed APs following renal transplants done between 2013 and 2023. PubMed and Scopus were searched for key words: pseudoaneurysm, aneurysm, arteritis, rupture, renal-transplant, allograft, kidney, mycotic, and fungal/infective. APs or bleeding from transplanted renal artery or anastomosis were included. APs secondary to transplanted renal artery stenosis, intervention, adjacent organ infection, pregnancy, intrarenal pseudoaneurysms, multiorgan transplants, unknown donor status and non-functional grafts were excluded. Results: Eight patients developed APs out of 714 transplants. The technique of in vivo cooling helped save one allograft. Six allografts were explanted. One patient died suddenly at home. After literature search, 199 cases were analyzed. One hundred sixty-four presented within 90 days of transplant (group A), 21 between 91 and 365 days (group B), and 14 after 365 days (group C). APs was evident in 111, and 88 presented with bleeding/hemorrhagic shock, including three deaths. Infective etiology was confirmed by histopathology or culture in 156 cases; Candida, Aspergillus, and Pseudomonas were the most common microbes. However, only 101 had clinical sepsis. Fifty-one had symptoms due to compression of adjacent artery/vein/nerve. Fifty-nine allografts (group A, 38; group B, 9; group C, 12) were saved out of 82 attempted. Nephrectomy with/without arterial reconstruction was done in 115, with recurrence in 26. There were 26 deaths, and all were in group A. Conclusions: APs in renal transplants though rare, result in high mortality and graft loss. Most occur within a year of transplant. Despite infective etiology, features of sepsis can be absent. Recurrence is high following salvage attempt or nephrectomy.http://www.sciencedirect.com/science/article/pii/S2949912725000510Anastomotic pseudoaneurysmHaemorrhageIn vivo cooling of transplanted kidneyRenal transplant |
| spellingShingle | Ajay Kumar Dabas, DNB Vishal Singh, DNB Brijesh Biswas, DNB Manvendu Jha, DNB Amit Agrawal, DNB Amit Shah, DNB Puneet Aggarwal, DNB Aditya Gupta, MCh Ajay Kumar Sharma, MS, FRCS Arterial anastomotic pseudoaneurysms in renal transplants: Case series and a scoping review JVS-Vascular Insights Anastomotic pseudoaneurysm Haemorrhage In vivo cooling of transplanted kidney Renal transplant |
| title | Arterial anastomotic pseudoaneurysms in renal transplants: Case series and a scoping review |
| title_full | Arterial anastomotic pseudoaneurysms in renal transplants: Case series and a scoping review |
| title_fullStr | Arterial anastomotic pseudoaneurysms in renal transplants: Case series and a scoping review |
| title_full_unstemmed | Arterial anastomotic pseudoaneurysms in renal transplants: Case series and a scoping review |
| title_short | Arterial anastomotic pseudoaneurysms in renal transplants: Case series and a scoping review |
| title_sort | arterial anastomotic pseudoaneurysms in renal transplants case series and a scoping review |
| topic | Anastomotic pseudoaneurysm Haemorrhage In vivo cooling of transplanted kidney Renal transplant |
| url | http://www.sciencedirect.com/science/article/pii/S2949912725000510 |
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