Falso aneurisma anastomótico em artéria de rim transplantado – opções terapêuticas para preservação do enxerto

Abstract

Extrarenal pseudoaneurysms are a rare complication of kidney transplantation, but result in graft loss in a majority of cases. The authors present the case of a 49 year old female patient who received a deceased‐donor kidney graft with arterial anastomosis to the right common iliac artery. Investigation for intermittent claudication of the right thigh at 5 months post‐transplant revealed an anastomotic pseudoaneurysm with distal occlusion of the external iliac artery. Treatment consisted of aneurysm resection and common iliac‐to‐renal artery bypass with great saphenous vein. The surgical specimen was positive for Candida albicans and the patient started on long‐term antifungal therapy. Routine Doppler ultrasound follow‐up revealed a new anastomotic pseudoaneurysm of the vein graft, with progressive enlargement to a diameter of 24 mm. The patient underwent endovascular exclusion of the pseudoaneurysm with a Viabahn® peripheral endograft (W.L. Gore and Ass. Inc., Flagstaff, AZ, USA), with good angiographic result and preservation of graft function. The described case illustrates how the use of different solutions in the vascular surgeon's armamentarium allows the successful treatment of kidney transplant complications while preserving graft function and contributing to a longer graft survival.