Int J Angiol
DOI: 10.1055/s-0040-1716327
Case Report

Life-Threatening Hematuria as Initial Presentation of a Complicated Transplant Renal Artery Pseudoaneurysm

Santiago J. Miyara*
1  Department of Surgery, Northwell Health, Manhasset, New York
2  Department of Emergency Medicine, Northwell Health, Manhasset, New York
3  Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
4  Lab. for Critical Care Physiology, Feinstein Institutes for Medical Research, Manhasset, New York
,
Lance B. Becker*
1  Department of Surgery, Northwell Health, Manhasset, New York
2  Department of Emergency Medicine, Northwell Health, Manhasset, New York
3  Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
4  Lab. for Critical Care Physiology, Feinstein Institutes for Medical Research, Manhasset, New York
,
Sara Guevara
1  Department of Surgery, Northwell Health, Manhasset, New York
2  Department of Emergency Medicine, Northwell Health, Manhasset, New York
,
Lawrence Lau
1  Department of Surgery, Northwell Health, Manhasset, New York
,
Vinay V. Nair
5  Department of Medicine, Northwell Health, Manhasset, New York
,
Nicholas Jandovitz
8  Department of Pharmacy, Northwell Health, Manhasset, New York
,
Ahmed E. Fahmy
1  Department of Surgery, Northwell Health, Manhasset, New York
,
Elliot Grodstein
1  Department of Surgery, Northwell Health, Manhasset, New York
,
Aaron M. Winnick
1  Department of Surgery, Northwell Health, Manhasset, New York
,
Claudia Kirsch
6  Department of Radiology, Northwell Health, Manhasset, New York
,
Daniel M. Rolston
1  Department of Surgery, Northwell Health, Manhasset, New York
2  Department of Emergency Medicine, Northwell Health, Manhasset, New York
,
Madhu C. Bhaskaran
1  Department of Surgery, Northwell Health, Manhasset, New York
5  Department of Medicine, Northwell Health, Manhasset, New York
,
Kei Hayashida
2  Department of Emergency Medicine, Northwell Health, Manhasset, New York
4  Lab. for Critical Care Physiology, Feinstein Institutes for Medical Research, Manhasset, New York
,
Koichiro Shinozaki
2  Department of Emergency Medicine, Northwell Health, Manhasset, New York
4  Lab. for Critical Care Physiology, Feinstein Institutes for Medical Research, Manhasset, New York
,
Ryosuke Takegawa
2  Department of Emergency Medicine, Northwell Health, Manhasset, New York
4  Lab. for Critical Care Physiology, Feinstein Institutes for Medical Research, Manhasset, New York
,
Young Min Cho
1  Department of Surgery, Northwell Health, Manhasset, New York
,
Joaquin A. Cagliani
1  Department of Surgery, Northwell Health, Manhasset, New York
3  Elmezzi Graduate School of Molecular Medicine, Manhasset, New York
,
Arton Isa
7  Department of Interventional Radiology, Northwell Health, Manhasset, New York
,
Mustafa Al-Roubaie
7  Department of Interventional Radiology, Northwell Health, Manhasset, New York
,
K. V. Krishnasastry
1  Department of Surgery, Northwell Health, Manhasset, New York
,
Lewis W. Teperman
1  Department of Surgery, Northwell Health, Manhasset, New York
,
Ernesto P. Molmenti
1  Department of Surgery, Northwell Health, Manhasset, New York
2  Department of Emergency Medicine, Northwell Health, Manhasset, New York
› Author Affiliations

Abstract

In this case report, we describe the clinical course of a complicated transplant renal artery (TRA) pseudoaneurysm, clinically featured by gross and massive hematuria one month after a kidney transplant was performed on a 50 year-old male patient. TRA pseudoaneurysm is a rare but potentially life-threatening complication that may result in bleeding, infection, graft dysfunction/loss, lower limb ischemia/loss, hemorrhagic shock, and death. TRA pseudoaneurysm treatment remains challenging as it needs to be tailored to the patient characteristics including hemodynamic stability, graft function, anatomy, presentation, and pseudoaneurysm features. This publication discusses the clinical scenario of massive gross hematuria that derived from a retroperitoneal hematoma which originated from an actively bleeding TRA pseudoaneurysm. This case highlights the combined approach of endovascular stent placement and subsequent transplant nephrectomy as a last resort in the management of intractable bleeding from a complicated TRA pseudoaneurysm. To the best of our knowledge, this is the first published case report of an actively bleeding TRA anastomotic pseudoaneurysm that caused a massive retroperitoneal bleed that in turn evacuated via the bladder after disrupting the ureter-to-bladder anastomosis. A temporizing hemostatic arterial stent placed percutaneously allowed for a safer and controlled emergency transplant nephrectomy.

* Both authors had equal contribution.




Publication History

Received: 03 May 2020

Accepted: 07 July 2020

Publication Date:
16 September 2020 (online)

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