Modality-specific occult intrarenal pseudoaneurysm in a renal allograft and the legacy of catheter angiography
Department of Radiology
Aged; Aneurysm, False; Aneurysm, Ruptured; Delayed Graft Function; Embolization, Therapeutic; Hematuria; Humans; Injections, Intralesional; Kidney Failure, Chronic; Kidney Transplantation; Male; Predictive Value of Tests; Renal Artery; Thrombin; Time Factors; Treatment Outcome; Ultrasonography, Doppler, Color
Cardiovascular Diseases | Radiology | Surgery
A 69-year-old man with history of end-stage-renal disease (ESRD) underwent successful kidney transplantation from a cadaveric donor in November 2011. However, posttransplant recovery was complicated by delayed graft function and recurrent gross hematuria. Serial Doppler ultrasound (US) of the renal allograft demonstrated a pseudoaneurysm with interval increase in size. However, it could not be visualized with other modalities, including an initial angiogram (postoperative day 49) and a second angiogram (postoperative day 68), followed by surgical exploration (postoperative day 71), which demonstrated complete intra-aneurysmal thrombosis on intraoperative Doppler US. Unfortunately, the patient's hematuria continued and a repeat Doppler US 48 hours later demonstrated a persistent pseudoaneurysm. Therefore, on postoperative day 75, we performed targeted percutaneous intra-aneurysmal thrombin injection under dual image guidance, which showed complete intra-aneurysmal thrombosis on intraprocedural Doppler US. Hematuria recurred the next day. A third angiogram (postoperative day 77) finally illuminated the hidden pseudoaneurysm occult on the first and second angiographic studies (sensitivity [index case] 33%) and surgery. This allowed for successful coil embolization of a subsegmental feeding branch with an excellent outcome. We support a more aggressive management with serial angiography and embolization of the intrarenal symptomatic pseudoaneurysm rather than surgery in renal allograft recipients, with the benefits outweighing the risks.
DOI of Published Version
Ann Vasc Surg. 2013 Nov;27(8):1184.e7-11. doi: 10.1016/j.avsg.2013.04.004. Link to article on publisher's site
Annals of vascular surgery
Rastogi, Neeraj; Williams, Gethin; and Alencar, Herlen, "Modality-specific occult intrarenal pseudoaneurysm in a renal allograft and the legacy of catheter angiography" (2013). Radiology Publications and Presentations. 37.