Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Actas Urol Esp (Engl Ed). 2021 Jun;45(5):335-344. doi: 10.1016/j.acuroe.2021.04.009. Epub 2021 May 14.
Infection of the artery at or around the anastomotic site is an ominous complication commonly presenting as a leak and/or local dissolution of the arterial wall.
Narrative review based on relevant PubMed, EMBASE, and Scielo indexed English or Spanish-written articles for the period January 2000-December 2019. A pooled analysis regarding etiology was performed. Based on the results obtained with this approach, a diagnostic/therapeutic algorithm is suggested in order to optimize its clinical management.
Arterial pseudoaneurysms are pseudocapsuled contained hematomas generated as the result of an arterial leaking. They are infrequent (<1% of cases), mostly related with infection (contamination of preservation fluid or sepsis) and located at the arterial anastomotic site in renal transplantation recipients. Although they are frequently diagnosed in symptomatic patients days/weeks after transplantation, they may remain unnoticed for long periods being diagnosed incidentally. Color coded-Doppler ultrasound confirms the clinical suspicion. Angio CT-scan and angiography are used for surgical planning or endovascular treatment, respectively. The etiological diagnosis is made on a basis of excised tissue culture. The decision-making process regarding the treatment approach, mostly relies on clinical presentation and anatomical location. Therapeutic options include ultrasound-guided percutaneous thrombin injection, endovascular treatment, and surgery.
Mycotic pseudoaneurysms in renal transplantation recipients may pose a significant challenge in cases of spontaneous rupture, given the risk for massive bleeding and death. Adequate management requires accurate diagnosis. Early endovascular stenting remains the treatment of choice in hemodynamically unstable patients. Percutaneous injection and vascular reconstruction present variable success rates in preserving graft function.
感染动脉吻合口处或周围的动脉是一种严重的并发症，通常表现为动脉壁的渗漏和/或局部溶解。
基于 2000 年 1 月至 2019 年 12 月期间在 PubMed、EMBASE 和 Scielo 索引的英文或西班牙文文献的相关文章进行叙述性综述。对病因进行了汇总分析。根据该方法的结果，提出了一个诊断/治疗算法，以优化其临床管理。
假性动脉瘤是由于动脉渗漏而产生的有假包膜的含血肿块。它们很少见（<1%的病例），主要与感染（保存液污染或败血症）有关，发生在肾移植受者的动脉吻合口处。尽管它们通常在移植后数天/数周有症状的患者中被诊断出来，但它们可能会在很长一段时间内被忽视，被偶然诊断出来。彩色多普勒超声可确认临床怀疑。血管 CT 扫描和血管造影分别用于手术规划和血管内治疗。病因诊断基于切除组织培养。治疗方法的决策过程主要取决于临床表现和解剖位置。治疗选择包括超声引导下经皮凝血酶注射、血管内治疗和手术。
肾移植受者的感染性假性动脉瘤在自发性破裂时可能会带来重大挑战，因为存在大出血和死亡的风险。适当的管理需要准确的诊断。早期血管内支架置入仍然是不稳定血流动力学患者的治疗选择。经皮注射和血管重建在保留移植物功能方面成功率不同。
