PMC5325110_01
CT scan of the abdomen and pelvis 3 months post-renal transplant shows (A) perinephric collection with gas density, and (B and C) a 3.8x3.5 cm infectious pseudoaneurysm of the graft renal artery. (D) 3-Dimensional reconstruction of the CT scan showing the pseudoaneurysm arising from the anastomosis between allograft renal artery and EIA (red arrow). The graft kidney is outlined by red triangles. (E) Postoperative 3-dimensional reconstruction of the CT scan showing patent vein graft and EIA. Graft kidney and pseudoaneurysm were removed.. Abbreviations: CT, computed tomography; EIA, external iliac artery; R, right; L, left; H, head; F, foot.
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PMC5325110_01_ijnrd-10-055Fig1.jpg
f1-ijnrd-10-055
A computed tomography (CT) scan of the abdomen and pelvis 3 months posttransplantation showed a 3.8x3.5 cm hyperdense, irregular, lobulated contrast outpouching of the right external iliac artery at the posteromedial aspect of the graft kidney, which represented an anastomotic pseudoaneurysm of the graft renal artery (Figure 1). Postoperatively, he made a good recovery on hemodialysis with no further sepsis, as evidenced by downtrend of inflammatory markers and resolution of fever. Postoperative 1 month CT scan and 4 months duplex ultrasound scan showed patent vein graft and resolution of collection (Figure 1).
(A) Intraoperative photos after graft nephrectomy and excision of pseudoaneurysm. Green arrow points to the large defect over EIA (marked by green triangles). (B) The distance between two ends of the EIA was too sizable to allow primary anastomosis. (C) Vascular reconstruction was achieved with reversed great saphenous vein interposition graft (marked by green triangles).. Abbreviation: EIA, external iliac artery.
ijnrd-10-055Fig2.jpg
PMC5325110_01_ijnrd-10-055Fig2.jpg
f2-ijnrd-10-055
He underwent emergency graft nephrectomy with resection of the right external iliac artery pseudoaneurysm and vascular reconstruction with in situ reversed great saphenous vein interposition graft harvested from the left thigh (Figure 2).