Endovascular Management of Mycotic Pseudoaneurysm After Pancreas Transplantation: Case Report and Literature Review
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Published on: February 9, 2024
Jinna Yao1, Mauro Vicaretti2, Taina Lee3
1Department 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.
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.
Insights
Mycotic pseudoaneurysms after pancreas transplant are rare. Endovascular repair can be a useful initial treatment, but often requires further surgery, especially in high-risk patients.
Area of Science:
- Transplantation Surgery
- Vascular Surgery
- Infectious Diseases
Background:
- Mycotic pseudoaneurysms are infrequent but serious complications following pancreas transplantation.
- Early diagnosis and prompt treatment, including surgery and antibiotics, are crucial for successful management.
- Traditional treatment involves open repair, but endovascular repair offers a less invasive alternative.
Observation:
- This study reports a case of mycotic pseudoaneurysm in a pancreas transplant recipient successfully managed with endovascular repair.
- A systematic literature review identified 14 additional cases of mycotic aneurysms in transplant recipients treated with endovascular repair.
Findings:
- Endovascular repair served as a viable bridging strategy in the reported case, facilitating definitive surgical treatment.
- In the literature, 54.5% of patients treated initially with endovascular stents required subsequent graft excision.
- Continued sepsis led to stent excision in 28.6% of cases, highlighting potential complications.
Implications:
- Endovascular management can be cautiously employed in high-risk transplant recipients as a temporary measure.
- Prolonged antibiotic therapy and close clinical monitoring are essential.
- A low threshold for allograft excision is recommended if clinical deterioration occurs.
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