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01-06-2013

Early and Late Presentations of Graft Arterial Pseudoaneurysm Following Pancreatic Transplantation

Authors: Nir Lubezky, Yaacov Goykhman, Richard Nakache, Ada Kessler, Roni Baruch, Paulina Katz, Itzhak Kori, Joseph M. Klausner, Menahem Ben-Haim

Published in: World Journal of Surgery | Issue 6/2013

Abstract

Background

Graft pseudoaneurysm (PSA) following pancreatic transplantation (PT) is a rarely reported complication that has significant morbidity and mortality. Few case reports and small series of this complication exist.

Methods

Retrospective review of files of 106 patients who underwent PT at the Tel-Aviv Sourasky Medical center between 1995 and 2010. Accessible asymptomatic patients (n = 35) were referred for graft PSA screening using ultrasound-Doppler.

Results

Eight patients developed graft PSA (8 %). All had early posttransplant sepsis. PSA incidence among patients who had perioperative sepsis is 13 %. Three patients developed early postoperative PSA, presenting as massive abdominal bleeding requiring urgent laparotomy and graft resection. Five patients were diagnosed with late-onset graft PSA between 3 months and 11 years posttransplant: clinical presentations were massive gastrointestinal bleeding (n = 2), acute renal failure (n = 1), and asymptomatic finding on screening ultrasound-Doppler (n = 2, 6 % of screened patients).

Conclusions

PSA following PT occurs in 8 % of patients. Perioperative infection is a risk factor. Early PSAs present as massive intra-abdominal bleeding. PSA may develop years posttransplant, may be asymptomatic, but late rupture is possible and presents as gastrointestinal bleeding. We recommend screening of patients at risk with ultrasound Doppler for early detection and treatment of asymptomatic PSAs.

Troppmann C, Gruessner AC, Benedetti E et al (1996) Vascular graft thrombosis after pancreatic transplantation: univariate and multivariate operative and nonoperative risk factor analysis. J Am Coll Surg 182(4):285–316PubMed

Sollinger HW, Stratta RJ, D’alessandro AM et al (1988) Experience with simultaneous pancreas-kidney transplantation. Ann Surg 208(4):475–483PubMedCrossRef

Ozaki CF, Stratta RJ, Taylor RJ et al (1992) Surgical complications in solitary pancreas and combined pancreas-kidney transplantations. Am J Surg 164(5):546–551PubMedCrossRef

Humar A, Ramcharan T, Kandaswami R et al (2004) Technical failures after pancreas transplants: why grafts fail and the risk factors–a multivariate analysis. Transplantation 78(8):1188–1192PubMedCrossRef

Tan M, Di Carlo A, Stein LA et al (2001) Pseudoaneurysm of the superior mesenteric artery after pancreas transplantation treated by endovascular stenting. Transplantation 72(2):336–338PubMedCrossRef

Khan TF, Ciancio G, Burke GW 3rd et al (1999) Pseudoaneurysm of the superior mesenteric artery with an arteriovenous fistula after simultaneous kidney-pancreas transplantation. Clin Transplant 13(3):277–279PubMedCrossRef

Paduch DA, Conlin M, Dematos A et al (2000) Arterial duodenovesical fistula after simultaneous pancreas and kidney transplantation. J Urol 164(4):1296PubMedCrossRef

Green BT, Tuttle-Newjall J, Suhocki P et al (2004) Massive gastrointestinal haemorrhage due to rupture of a donor pancreatic artery pseudoaneurysm in a pancreas transplant patient. Clin Transplant 18:108–111PubMedCrossRef

Verni MP, Leone JP, DeRoover A et al (2001) Pseudoaneurysm of the Y-graft/iliac artery anastomosis following pancreas transplantation: a case report and review of the literature. Clin Transplant 15:72–76PubMedCrossRef

10.

Tzakis AG, Carroll PB, Gordon RD et al (1989) Arterial mycotic aneurysm and rupture. A potentially fatal complication of pancreas transplantation in diabetes mellitus. Arch Surg 124(6):660–661PubMedCrossRef

11.

Fujita S, Fujikawa T, Mekeel KL et al (2006) Successful endovascular treatment of a leaking pseudoaneurysm without graft loss after simultaneous pancreas and kidney transplantation. Transplantation 82(5):717–718PubMedCrossRef

12.

Stratta RJ (1997) Donor age, organ import, and cold ischemia: effect on early outcome after simultaneous kidney-pancreas transplantation. Transplant Proc 29:3291–3292PubMedCrossRef

13.

Robertson RP, Sutherland DER, Kendall DM et al (1996) Metabolic characterization or long term successful pancreas transplantation in type 1 diabetes. J Invest Med 44:1–7

14.

Troppmann C, Gruessner AC, Dunn DL et al (1998) Surgical complications requiring early relaparotomy after pancreas transplantation: a multivariate risk factor and economic impact analysis of the cyclosporine era. Ann Surg 227:255–268PubMedCrossRef

15.

Sansalone CV, Maione G, Aseni P et al (2005) Surgical complications are the main cause of pancreatic allograft loss in pancreas-kidney transplant recipients. Transplant Proc 37:2651–2653PubMedCrossRef

16.

Yekebas E, Wolfram L, Cataldehirmen G et al (2007) Postpancreatectomy hemorrhage: diagnosis and treatment. An analysis in 1669 consecutive pancreatic resections. Ann Surg 246(2):269–280PubMedCrossRef

17.

Choi SH, Moon HJ, Heo SJ et al (2004) Delayed hemorrhage after pancreaticoduodenectomy. J Am Coll Surg 199:186–191PubMedCrossRef

18.

Sato N, Yamaguchi K, Shimizu S et al (1998) Coil embolization of bleeding visceral pseudoaneurysms following pancreatectomy: the importance of early angiography. Arch Surg 133:1099–1102PubMedCrossRef

19.

Michalak G, Kwatiatkowski A, Beniasz M et al (2005) Infectious complications after simultaneous pancreas-kidney transplantation. Transplant Proc 37:3560–3563PubMedCrossRef

20.

Berger N, Wirmsberger R, Kafka R et al (2006) Infectious complications following 72 consecutive enteric-drained pancreas transplants. Transpl Int 19:549–557PubMedCrossRef

21.

Al-Hasan MN, Razonable RR, Eckel-Passow JE et al (2009) Incidence rate and outcome of gram-negative bloodstream infection in solid organ transplant recipients. Am J Transplant 9:835–843PubMedCrossRef

22.

Fontana I, Bertocchi I, Diviacco P et al (2009) Infections after simultaneous pancreas and kidney transplantation: a single center experience. Transpl Proc 41(4):1333–1335CrossRef

23.

Bassitti M, Salvalaggio PRO, Topal J et al (2004) Incidence, timing and site of infections among pancreas transplant recipients. J Hosp Infect 56:184–190CrossRef

24.

Humar A, Kandaswamy R, Granger D et al (2000) Decreased surgical risks of pancreas transplantation in the modern era. Ann Surg 231(2):269–275PubMedCrossRef

25.

Benedetti E, Gruessner AC, Troppmann C et al (1996) Intra-abdominal fungal infections after pancreatic transplantation: incidence, treatment, and outcome. J Am Coll Surg 183(4):408–410

Title: Early and Late Presentations of Graft Arterial Pseudoaneurysm Following Pancreatic Transplantation
Authors: Nir Lubezky
Yaacov Goykhman
Richard Nakache
Ada Kessler
Roni Baruch
Paulina Katz
Itzhak Kori
Joseph M. Klausner
Menahem Ben-Haim
Publication date: 01-06-2013
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 6/2013
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-013-1972-2

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Springer Medicine

Early and Late Presentations of Graft Arterial Pseudoaneurysm Following Pancreatic Transplantation

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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