PDF(Sci-hub)
Abstract：
BACKGROUND: Infection of the artery at or around the anastomotic site is an ominous complication commonly presenting as a leak and/or local dissolution of the arterial wall.
METHODS: Narrative review based on relevant PubMed, EMBASE, and Scielo indexed English or Spanish-written articles for the period January 2000-December 2019. A pooled analysis regarding etiology was performed. Based on the results obtained with this approach, a diagnostic/therapeutic algorithm is suggested in order to optimize its clinical management.
RESULTS: Arterial pseudoaneurysms are pseudocapsuled contained hematomas generated as the result of an arterial leaking. They are infrequent (<1% of cases), mostly related with infection (contamination of preservation fluid or sepsis) and located at the arterial anastomotic site in renal transplantation recipients. Although they are frequently diagnosed in symptomatic patients days/weeks after transplantation, they may remain unnoticed for long periods being diagnosed incidentally. Color coded-Doppler ultrasound confirms the clinical suspicion. Angio CT-scan and angiography are used for surgical planning or endovascular treatment, respectively. The etiological diagnosis is made on a basis of excised tissue culture. The decision-making process regarding the treatment approach, mostly relies on clinical presentation and anatomical location. Therapeutic options include ultrasound-guided percutaneous thrombin injection, endovascular treatment, and surgery.
CONCLUSIONS: Mycotic pseudoaneurysms in renal transplantation recipients may pose a significant challenge in cases of spontaneous rupture, given the risk for massive bleeding and death. Adequate management requires accurate diagnosis. Early endovascular stenting remains the treatment of choice in hemodynamically unstable patients. Percutaneous injection and vascular reconstruction present variable success rates in preserving graft function.
METHODS: Narrative review based on relevant PubMed, EMBASE, and Scielo indexed English or Spanish-written articles for the period January 2000-December 2019. A pooled analysis regarding etiology was performed. Based on the results obtained with this approach, a diagnostic/therapeutic algorithm is suggested in order to optimize its clinical management.
RESULTS: Arterial pseudoaneurysms are pseudocapsuled contained hematomas generated as the result of an arterial leaking. They are infrequent (<1% of cases), mostly related with infection (contamination of preservation fluid or sepsis) and located at the arterial anastomotic site in renal transplantation recipients. Although they are frequently diagnosed in symptomatic patients days/weeks after transplantation, they may remain unnoticed for long periods being diagnosed incidentally. Color coded-Doppler ultrasound confirms the clinical suspicion. Angio CT-scan and angiography are used for surgical planning or endovascular treatment, respectively. The etiological diagnosis is made on a basis of excised tissue culture. The decision-making process regarding the treatment approach, mostly relies on clinical presentation and anatomical location. Therapeutic options include ultrasound-guided percutaneous thrombin injection, endovascular treatment, and surgery.
CONCLUSIONS: Mycotic pseudoaneurysms in renal transplantation recipients may pose a significant challenge in cases of spontaneous rupture, given the risk for massive bleeding and death. Adequate management requires accurate diagnosis. Early endovascular stenting remains the treatment of choice in hemodynamically unstable patients. Percutaneous injection and vascular reconstruction present variable success rates in preserving graft function.
摘要：
背景：吻合部位或周围的动脉感染是一种不祥的并发症，通常表现为动脉壁的渗漏和/或局部溶解。
方法：基于相关PubMed的叙事回顾，EMBASE,Scielo索引了2000年1月至2019年12月期间的英语或西班牙语文章。进行了有关病因的汇总分析。根据这种方法获得的结果，建议采用诊断/治疗算法以优化其临床管理。
结果：动脉假性动脉瘤是由于动脉渗漏而产生的假囊内含血肿。它们很少见（<1％的病例），主要与感染（保存液污染或败血症）有关，位于肾移植受者的动脉吻合部位。尽管它们经常在移植后几天/几周的有症状的患者中被诊断出来，他们可能会在长期被诊断为偶然的情况下被忽视。彩色多普勒超声证实了临床怀疑。血管造影和血管造影用于手术计划或血管内治疗，分别。病因诊断是根据切除的组织培养物进行的。关于治疗方法的决策过程，主要依赖于临床表现和解剖位置。治疗方案包括超声引导经皮凝血酶注射,血管内治疗,和手术。
结论：肾移植受者的真菌性假性动脉瘤在自发性破裂病例中可能构成重大挑战，考虑到大量出血和死亡的风险。充分的管理需要准确的诊断。早期血管内支架置入仍然是血流动力学不稳定患者的首选治疗方法。经皮注射和血管重建在保留移植物功能方面具有可变的成功率。
方法：基于相关PubMed的叙事回顾，EMBASE,Scielo索引了2000年1月至2019年12月期间的英语或西班牙语文章。进行了有关病因的汇总分析。根据这种方法获得的结果，建议采用诊断/治疗算法以优化其临床管理。
结果：动脉假性动脉瘤是由于动脉渗漏而产生的假囊内含血肿。它们很少见（<1％的病例），主要与感染（保存液污染或败血症）有关，位于肾移植受者的动脉吻合部位。尽管它们经常在移植后几天/几周的有症状的患者中被诊断出来，他们可能会在长期被诊断为偶然的情况下被忽视。彩色多普勒超声证实了临床怀疑。血管造影和血管造影用于手术计划或血管内治疗，分别。病因诊断是根据切除的组织培养物进行的。关于治疗方法的决策过程，主要依赖于临床表现和解剖位置。治疗方案包括超声引导经皮凝血酶注射,血管内治疗,和手术。
结论：肾移植受者的真菌性假性动脉瘤在自发性破裂病例中可能构成重大挑战，考虑到大量出血和死亡的风险。充分的管理需要准确的诊断。早期血管内支架置入仍然是血流动力学不稳定患者的首选治疗方法。经皮注射和血管重建在保留移植物功能方面具有可变的成功率。
