Stern Jeffrey, Negash Bruck, Hickey Ryan, Lugo Joanelle, Cayne Neal S, Lonze Bonnie E, Ali Nicole M, Stewart Zoe A
From the Transplant Institute, NYU Langone Health, New York, New York, USA.
Exp Clin Transplant. 2023 Feb;21(2):175-179. doi: 10.6002/ect.2022.0326.
Mycotic pseudoaneurysms are a rare, life-threatening complication after pancreas transplant. There have been limited reports of endovascular treatment of mycotic pseudoaneurysms in pancreas transplant recipients. Herein, we report on a case of a mycotic pseudoaneurysm from Pseudomonas aeruginosa after pancreas transplant. A 53-year-old male recipient underwent an uneventful simultaneous pancreas and kidney transplant. He was readmitted 48 days posttransplant with fevers and rigors. Pan-cultures were performed and broad-spectrum antibiotics were initiated. Imaging studies demonstrated a large mycotic pseudoaneurysm arising from the right common iliac artery adjacent to the arterial Y-graft anastomosis of the transplant pancreas. Endovascular stent placement was used to exclude the pseudoaneurysm prior to transplant pancreatectomy. During pancreatectomy, the lateral wall of the common iliac artery was found to be necrotic with significant exposure of the endovascular stent. After ligation and excision of the common iliac artery, a femorofemoral bypass was performed to revascularize the lower extremity. This case report highlights the advantage of a staged endovascular and surgical management strategy for complex mycotic pseudoaneurysms after pancreas transplant.
真菌性假性动脉瘤是胰腺移植后一种罕见的、危及生命的并发症。关于胰腺移植受者真菌性假性动脉瘤的血管内治疗的报道有限。在此，我们报告一例胰腺移植后由铜绿假单胞菌引起的真菌性假性动脉瘤病例。一名53岁男性受者接受了顺利的同期胰腺和肾脏移植。移植后48天，他因发热和寒战再次入院。进行了全面培养并开始使用广谱抗生素。影像学研究显示，在移植胰腺的动脉Y形移植物吻合口附近的右髂总动脉出现一个大型真菌性假性动脉瘤。在进行移植胰腺切除术前，采用血管内支架置入术来排除假性动脉瘤。在胰腺切除术中，发现髂总动脉侧壁坏死，血管内支架明显暴露。在结扎和切除髂总动脉后，进行了股-股旁路移植术以使下肢重新血管化。本病例报告强调了胰腺移植后复杂真菌性假性动脉瘤采用分期血管内和手术治疗策略的优势。
