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一种管理肾移植术后霉菌性假性动脉瘤的新型混合方法:成功保留移植肾

A Novel Hybrid Approach to Manage Mycotic Pseudoaneurysm Post-Renal Transplantation: Successful Graft Preservation.

作者信息

Li Ho, Lin Yi-Chang, Kao Chien-Chang, Chiang Pei-Jhang, Chou Meng-Han, Ting Hui-Kung, Jhuo Yu-Cing, Yang Ming-Hsin, Tsao Chih-Wei, Meng En, Sun Guang-Huan, Yu Dah-Shyong, Chang Sun-Yran, Chen Chin-Li, Wu Sheng-Tang

机构信息

Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.

Division of Urology, Department of Surgery, Gangshan Branch of Zuoying Armed Forces General Hospital, Kaohsiung 820, Taiwan.

出版信息

Medicina (Kaunas). 2025 Mar 17;61(3):521. doi: 10.3390/medicina61030521.

Abstract

: Post-transplant anastomotic pseudoaneurysms are a rare but serious complication of renal transplantation, typically requiring graft sacrifice. This case report demonstrates a novel hybrid approach for managing a mycotic pseudoaneurysm while preserving graft function. A 56-year-old male developed a pseudoaneurysm at the anastomotic site after cadaveric kidney transplantation, presenting with recurrent infections and declining renal function. Imaging confirmed the pseudoaneurysm. A hybrid strategy combining femoral-femoral bypass with a polytetrafluoroethylene graft, percutaneous transluminal angioplasty with stenting, and coil embolization was performed. : The intervention successfully isolated the pseudoaneurysm and preserved graft function. Post-procedure, serum creatinine levels improved, stabilizing at 2.3 mg/dL during follow-up. Imaging confirmed no residual flow in the aneurysm, and vascular complications were absent. : This report highlights a successful combined surgical and endovascular approach for treating mycotic pseudoaneurysms, preserving graft function and restoring limb blood flow. This strategy offers a promising alternative for managing complex post-transplant complications, though long-term outcomes require further evaluation.

摘要

移植后吻合口假性动脉瘤是肾移植中一种罕见但严重的并发症,通常需要切除移植肾。本病例报告展示了一种在保留移植肾功能的同时处理感染性假性动脉瘤的新型联合方法。一名56岁男性在尸体肾移植后吻合口处出现假性动脉瘤,表现为反复感染和肾功能下降。影像学检查证实了假性动脉瘤的存在。实施了一种联合策略,包括股-股旁路移植术、聚四氟乙烯移植物、经皮腔内血管成形术加支架置入以及弹簧圈栓塞术。该干预成功隔离了假性动脉瘤并保留了移植肾功能。术后,血清肌酐水平改善,随访期间稳定在2.3mg/dL。影像学检查证实动脉瘤内无残余血流,且无血管并发症。本报告强调了一种成功的外科手术与血管腔内治疗相结合的方法来治疗感染性假性动脉瘤,保留移植肾功能并恢复肢体血流。尽管长期疗效需要进一步评估,但该策略为处理复杂的移植后并发症提供了一种有前景的替代方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5996/11943577/38419071f73b/medicina-61-00521-g001.jpg

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