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

Autor:	Miyara SJ; Department of Surgery, Northwell Health, Manhasset, New York.; Department of Emergency Medicine, Northwell Health, Manhasset, New York.; Elmezzi Graduate School of Molecular Medicine, Manhasset, New York.; Lab. for Critical Care Physiology, Feinstein Institutes for Medical Research, Manhasset, New York., Becker LB; Department of Surgery, Northwell Health, Manhasset, New York.; Department of Emergency Medicine, Northwell Health, Manhasset, New York.; Elmezzi Graduate School of Molecular Medicine, Manhasset, New York.; Lab. for Critical Care Physiology, Feinstein Institutes for Medical Research, Manhasset, New York., Guevara S; Department of Surgery, Northwell Health, Manhasset, New York.; Department of Emergency Medicine, Northwell Health, Manhasset, New York., Lau L; Department of Surgery, Northwell Health, Manhasset, New York., Nair VV; Department of Medicine, Northwell Health, Manhasset, New York., Jandovitz N; Department of Pharmacy, Northwell Health, Manhasset, New York., Fahmy AE; Department of Surgery, Northwell Health, Manhasset, New York., Grodstein E; Department of Surgery, Northwell Health, Manhasset, New York., Winnick AM; Department of Surgery, Northwell Health, Manhasset, New York., Kirsch C; Department of Radiology, Northwell Health, Manhasset, New York., Rolston DM; Department of Surgery, Northwell Health, Manhasset, New York.; Department of Emergency Medicine, Northwell Health, Manhasset, New York., Bhaskaran MC; Department of Surgery, Northwell Health, Manhasset, New York.; Department of Medicine, Northwell Health, Manhasset, New York., Hayashida K; Department of Emergency Medicine, Northwell Health, Manhasset, New York.; Lab. for Critical Care Physiology, Feinstein Institutes for Medical Research, Manhasset, New York., Shinozaki K; Department of Emergency Medicine, Northwell Health, Manhasset, New York.; Lab. for Critical Care Physiology, Feinstein Institutes for Medical Research, Manhasset, New York., Takegawa R; Department of Emergency Medicine, Northwell Health, Manhasset, New York.; Lab. for Critical Care Physiology, Feinstein Institutes for Medical Research, Manhasset, New York., Cho YM; Department of Surgery, Northwell Health, Manhasset, New York., Cagliani JA; Department of Surgery, Northwell Health, Manhasset, New York.; Elmezzi Graduate School of Molecular Medicine, Manhasset, New York., Isa A; Department of Interventional Radiology, Northwell Health, Manhasset, New York., Al-Roubaie M; Department of Interventional Radiology, Northwell Health, Manhasset, New York., Krishnasastry KV; Department of Surgery, Northwell Health, Manhasset, New York., Teperman LW; Department of Surgery, Northwell Health, Manhasset, New York., Molmenti EP; Department of Surgery, Northwell Health, Manhasset, New York.; Department of Emergency Medicine, Northwell Health, Manhasset, New York.
Jazyk:	angličtina
Zdroj:	The International journal of angiology : official publication of the International College of Angiology, Inc [Int J Angiol] 2020 Sep 16; Vol. 32 (4), pp. 253-257. Date of Electronic Publication: 2020 Sep 16 (Print Publication: 2023).
DOI:	10.1055/s-0040-1716327
Abstrakt:	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. Competing Interests: Conflict of Interest None declared. (International College of Angiology. This article is published by Thieme.)
Databáze:	MEDLINE
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