Endovascular Management of Mycotic Pseudoaneurysm After Pancreas Transplantation: Case Report and Literature Review

Jinna Yao; Mauro Vicaretti; Taina Lee; Rajith Amaratunga; Nicholas Cocco; Jerome Laurence; Natasha Rogers; Germaine Wong; Angela Webster; Wayne Hawthorne; Howard Lau; Richard Allen; Lawrence Yuen; Henry Pleass

doi:10.1016/j.transproceed.2019.09.015

Endovascular Management of Mycotic Pseudoaneurysm After Pancreas Transplantation: Case Report and Literature Review

Transplant Proc. 2020 Mar;52(2):660-666. doi: 10.1016/j.transproceed.2019.09.015. Epub 2020 Feb 17.

Authors

Jinna Yao¹, Mauro Vicaretti², Taina Lee³, Rajith Amaratunga⁴, Nicholas Cocco⁴, Jerome Laurence⁵, Natasha Rogers⁶, Germaine Wong⁶, Angela Webster⁷, Wayne Hawthorne⁸, Howard Lau⁹, Richard Allen¹⁰, Lawrence Yuen¹¹, Henry Pleass¹²

Affiliations

¹ Department of Urology, Westmead Hospital, Sydney, Australia; Department of Surgery, Westmead Hospital, Sydney, Australia; Discipline of Surgery, University of Sydney Medical School, Sydney, Australia; National Pancreas Transplant Unit, Westmead Hospital, Sydney, Australia.
² Department of Vascular Surgery, Westmead Hospital, Sydney, Australia.
³ Department of Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
⁴ Department of Surgery, Westmead Hospital, Sydney, Australia; National Pancreas Transplant Unit, Westmead Hospital, Sydney, Australia.
⁵ Department of Surgery, Westmead Hospital, Sydney, Australia; Discipline of Surgery, University of Sydney Medical School, Sydney, Australia; National Pancreas Transplant Unit, Westmead Hospital, Sydney, Australia; Department of Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
⁶ National Pancreas Transplant Unit, Westmead Hospital, Sydney, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia; Department of Renal Medicine, Westmead Hospital, Sydney, Australia.
⁷ National Pancreas Transplant Unit, Westmead Hospital, Sydney, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia; Department of Renal Medicine, Westmead Hospital, Sydney, Australia; School of Public Health, University of Sydney, Sydney, Australia.
⁸ Discipline of Surgery, University of Sydney Medical School, Sydney, Australia; National Pancreas Transplant Unit, Westmead Hospital, Sydney, Australia.
⁹ Department of Urology, Westmead Hospital, Sydney, Australia; Discipline of Surgery, University of Sydney Medical School, Sydney, Australia.
¹⁰ Department of Surgery, Westmead Hospital, Sydney, Australia; Discipline of Surgery, University of Sydney Medical School, Sydney, Australia; Department of Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
¹¹ Department of Surgery, Westmead Hospital, Sydney, Australia; Discipline of Surgery, University of Sydney Medical School, Sydney, Australia; National Pancreas Transplant Unit, Westmead Hospital, Sydney, Australia.
¹² Department of Surgery, Westmead Hospital, Sydney, Australia; Discipline of Surgery, University of Sydney Medical School, Sydney, Australia; National Pancreas Transplant Unit, Westmead Hospital, Sydney, Australia. Electronic address: henry.pleass@sydney.edu.au.

PMID: 32081354
DOI: 10.1016/j.transproceed.2019.09.015

Abstract

Introduction: Mycotic pseudoaneurysm is a rare complication of pancreas transplantation. Successful management relies on early diagnosis and expedient treatment comprising surgery and antibiotics. While the standard of care in recipients of pancreatic transplants is open repair of pseudoaneurysm with or without excision of the allograft, endovascular management has been reported. Endovascular repair is a less invasive treatment option with advantages of expedient control of hemorrhage, avoidance of adhesions with an open repair, and greater suitability for elderly and frail patients.

Material and methods: We report a case of a 40-year-old recipient of a pancreas transplant who had a mycotic pseudoaneurysm managed with endovascular repair. A systematic search of PubMed-MEDLINE, Embase, and Cochrane Library was performed of all cases of mycotic aneurysms following pancreas or kidney transplantation managed with endovascular repair.

Results: There were 14 cases of mycotic aneurysms in transplant recipients managed with endovascular repair in the literature. Of those who received an endovascular stent as the only initial management strategy, 6 (54.5%) required a subsequent graft excision. Four (28.6%) patients required excision of their stent due to continued sepsis. There was 1 death from unrelated causes.

Conclusions: Endovascular repair was a reasonable bridging technique to further definitive surgical treatment in our case. Endovascular management may be used with caution in high-risk patients. We advocate for prolonged antibiotic therapy combined with vigilant surveillance of the clinical response, and a low threshold for allograft excision in the event of clinical deterioration.

Publication types

Case Reports
Review

MeSH terms

Adult
Aneurysm, False / etiology*
Aneurysm, False / surgery*
Aneurysm, Infected / etiology*
Aneurysm, Infected / surgery*
Endovascular Procedures / methods
Humans
Male
Pancreas Transplantation / adverse effects*
Postoperative Complications / etiology
Postoperative Complications / surgery*
Stents / adverse effects