Management of mycotic pseudoaneurysms in renal transplant patients - a literature review and proposal for a novel management pathway

You have accessJournal of UrologyCME1 Apr 2023MP31-10 MANAGEMENT OF MYCOTIC PSEUDOANEURYSMS IN RENAL TRANSPLANT PATIENTS - A LITERATURE REVIEW AND PROPOSAL FOR A NOVEL MANAGEMENT PATHWAY Alexandra Bain, Gerrit Winkelaar, and Max Levine Alexandra BainAlexandra Bain More articles by this author , Gerrit WinkelaarGerrit Winkelaar More articles by this author , and Max LevineMax Levine More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003264.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Vascular complications represent the main cause of early graft loss in renal transplantations—with less than 1% of these cases developing mycotic pseudoaneurysms. The morbidity and mortality associated with this complication is significant with an overall mortality rate of 15-20% and a graft loss rate of 55-70%. Currently the gold standard treatment for mycotic pseudoaneurysms is undefined. Recently there have been three renal transplant patients at the University of Alberta Hospital who developed mycotic pseudoaneurysms with different surgical repairs and outcomes. We performed a quality assurance review and a literature review of the surgical management of mycotic pseudoaneurysms. Based on this review, we have proposed a novel management pathway which may help reduce post-operative complications. METHODS: The databases MEDLINE and SCOPUS were searched for all case reports describing management of mycotic pseudoaneurysms in renal transplant patients between years 1990-2022. RESULTS: Twenty-two articles were reviewed which described forty-one case reports of mycotic pseudoaneurysms in renal transplant recipients. Repair techniques included patch repair in 61% of cases (25/41), endovascular stenting in 22% of cases (9/41), and extra-anatomical bypass in 12% of cases (5/41), 5% of patients (2/41) had a post-mortem diagnosis. The failure rates of patch repair resulting in death or repeat surgery was 44% (11/25), failure rates for stents was 22% (2/9), failure rates of extra-anatomical bypass was 0%. Every patient who required a takeback operative procedure was managed with an extra-anatomical bypass. Overall patient mortality was 17% (7/41), overall graft loss rate was 68% (28/41). CONCLUSIONS: Considering the high failure rates of patch repairs and endovascular stents, we suggest the first-line strategy for repair should be an extra-anatomical bypass with the assistance of Vascular Surgery when possible. If an extra-anatomical bypass cannot be performed, we suggest a wide surgical debridement with autologous in-line reconstruction. These surgical approaches may help decrease the incidence of surgical failure rates and mortalities. Having a standardized management pathway utilized by Transplant Urology and Vascular Surgery may allow for improved patient surgical outcomes and graft survival outcomes in the future. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e433 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandra Bain More articles by this author Gerrit Winkelaar More articles by this author Max Levine More articles by this author Expand All Advertisement PDF downloadLoading ...