Transplant renal artery false aneurysm: case report and literature review

Abstract

This is a case report of a 59 years old male who had a commercial non-related living renal transplantation for his end stage renal insufficiency secondary to adult polycystic kidney disease. He suffered an immediate and early post-operative bleeding, which was managed conservatively. He was presented at Sultan Qaboos University Hospital four months after his transplant with abdominal pain, nausea, loss of appetite and a rise in serum creatinine levels. Ultrasonography and angiography have shown a 4 cm false aneurysm of the transplant renal artery at the anastomotic site with the external iliac artery. Surgical exploration with resection of the false aneurysm and reanastomosis of the donor renal artery to the external iliac artery was carried out successfully with preservation of the renal allograft. This is a rare case of an extra-renal false aneurysm at the anastomotic site of the transplant renal artery to the external iliac artery four months after renal allotransplantation. Literature review on the management and outcome of false aneurysms after renal transplant was carried out.

Figure 1a

B-mode Ultrasonography. A hypoechoic mass with centrally anechoic lesion next to the upper pole of the renal allograft.

Figure 1b

Color-Coded Doppler Sonography (CCDS) showed a pulsatile flow pattern in the central anechoic part of the lesion.

Figure 2a

Angiography has showed a 4x4 cm false aneurysm at the junction of the transplanted renal artery with the right sided external iliac artery.

Figure 2b

3 Dimensional Angiography reconstruction view showing the 4x4 cm false aneurysm at the junction of the transplanted renal artery with the right sided external iliac artery.

Figure 3a

Operative finding of the false aneurysm (FA), proximal and distal Vascular control over the right sided external iliac artery, vascular control over the transplanted renal artery (TRA). Transplanted Kidney (TK).

Figure 3b

false aneurysm incised and then resected.

Figure 4

a post operative Color-coded Doppler sonography (CCDS) show patent renal allograft artery & vein.