PMC3109788_01
Ultrasound image (a) and computed tomography image (b) showing the hematoma (arrows) within the abdominal wall overlying the graft kidney
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Ultrasonography showed a hematoma within the abdominal wall overlying the graft kidney with no perinephric fluid [Figure 1a]. The hematoma increased in size the next day and a non-enhanced CT scan was done [Figure 1b].
Digital subtraction angiography image showing a pseudoaneurysm (arrow) arising from the ascending branch of the deep circumflex iliac artery. Embolisation coils are seen within the lower pole of the graft kidney. The post-embolisation angiogram (b) showed stasis in the supplying vessel
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Additionally, a pseudoaneurysm arising from the ascending branch of the deep circumflex iliac artery was seen [Figure 2a], which was embolized using gelfoam slurry and polyvinyl alcohol (PVA) particles [Figure 2b].
Digital subtraction angiography image of the second session showing the pseudoaneurysm (arrow) being filled by small anastomosing vessels
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Since the hematocrit did not stabilize despite transfusion of blood, platelets and fresh frozen plasma, a repeat angiogram with left common femoral artery approach and selective cannulation of the internal mammary artery was done which revealed persistent opacification of the pseudoaneurysm by collateral vessels in the right iliac fossa [Figure 3].
(a) Digital subtraction angiography image showing multiple anastomosing branches (arrow) of the superior epigastric artery anastomosing in the right lower abdomen. Radioopaque cholecystectomy clips are also seen (b) Post embolisation angiogram showing stasis in the superior epigastric artery
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Using a 4F Glide Headhunter (Cook, Bloomington, USA) catheter and coaxial microcatheter technique, a selective angiogram of the right internal mammary artery was done to demonstrate the superior epigastric artery and its anastomosing vessels branching toward the right lower abdomen [Figure 4a] which were embolized using PVA particles and gelfoam slurry [Figure 4b].