Juxta Anastomotic Renal Artery pseudoaneurysms (rPA) although uncommon, are a cpotentially catastrophic complication in renal transplant. The indice is les than 0.5% (Bracala et al 2010). Numerous documented cases have revealed reconstructive surgery in rPA is high risk and often unsuccesful leading to graft loss. Nephrectomy in this instance may reduce mortality and morbidity in the short term but there are significant longer term repercussions related to graft loss. Significant advances in interentional radiology in the last decade have pared the way for an alternative to the higher risk open surgical approach to rPA.
This single centre case series presents the outcomes of management of juxta-anastomotic rPA in five transplant recipients. The series include 4 male and 1 female patients with a mean age of 55. All donor kidneys were cadaveric. Mean donor age was 42, All transplants were done in a standar fachion with single arteries on a patch to the external iliac artery. All five patients were investigated for elevated serum creatinine and/or resistant hypertension. Abnormalultrasound findings were folloved up with magnetic resonance imaging. 3 out of 5 patients had coexisting renal artery stenosis.
The three patients with co-existing RAS had angioplasty of the stenotic segments followed by embolization using coils, Onyx and PVA. All three patients are currently well with good function. Two patients had suspected mycotic aneurysm. One had and external iliac artery stent inserted radiologically. The second patient was initially treated with thromin injection followed by stents. However dur to on-going sepsis both patients required delayed nephrectomy.
Radiological treatment is feasible and effective for treating juxta-anastomotic psudoaneurysm in renal transplants with graft preserving outcomes in non septic patients.