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Explant and Bypass for Polymicrobial Mycotic Pseudoaneurysm Following Renal Transplant
Hanna D Sun1, William J Lain1, Erin Buchanan2
1School of Medicine, University of Virginia, Charlottesville, VA, USA.
Abstract:
Mycotic pseudoaneurysms in renal transplant patients are rare but serious complications associated with significant morbidity, graft loss, and mortality. They present a critical management challenge between endovascular salvage and definitive surgical explant. While contemporary reports suggest endovascular techniques can successfully treat this condition, their role as definitive treatment in fungal fields is controversial. We report a case where repeated endovascular stent treatment of a polymicrobial fungal and bacterial pseudoaneurysm perpetuated biofilm formation and polymicrobial colonization, enabling ongoing infection and ultimately requiring explant and femoral-femoral bypass for definitive source control and revascularization. This case highlights an important decision threshold: in the setting of angioinvasive molds, endovascular salvage is often futile, with recent series showing a high failure rate for allograft preservation. Recognition of persistent pain and recurrent fluid collections following endovascular therapy should trigger early surgical source control with infection-resistant conduits, such as autologous or cryopreserved allografts, rather than endovascular temporization.
Insights
Mycotic pseudoaneurysms in kidney transplant patients are rare but serious. Repeated endovascular treatment can worsen infection, highlighting the need for early surgical intervention with infection-resistant grafts for better outcomes.
Area of Science:
- Nephrology
- Transplant Surgery
- Infectious Diseases
Background:
- Mycotic pseudoaneurysms are rare, severe complications in renal transplant recipients.
- Management involves a critical choice between endovascular salvage and surgical explant.
- The efficacy of endovascular treatment as a definitive approach in fungal infections remains debated.
Purpose of the Study:
- To report a case of recurrent mycotic pseudoaneurysm in a renal transplant patient.
- To analyze the impact of repeated endovascular stent treatment on infection persistence.
- To emphasize the importance of surgical source control in specific cases.
Main Methods:
- Case report of a renal transplant recipient with a polymicrobial (fungal and bacterial) pseudoaneurysm.
- Description of repeated endovascular stent placements.
- Details of subsequent surgical explant and femoral-femoral bypass.
Main Results:
- Repeated endovascular treatment perpetuated biofilm formation and polymicrobial colonization.
- The patient ultimately required explant and bypass for definitive treatment.
- Endovascular salvage showed a high failure rate in preserving the allograft in this context.
Conclusions:
- In cases of angioinvasive molds, endovascular salvage is often futile.
- Persistent symptoms post-endovascular therapy warrant early surgical source control.
- Infection-resistant conduits are preferred over endovascular temporization for definitive management.
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