Significant arterial complications after pancreas transplantation-A single-center experience and review of literature. Clin Transplant 2017 Oct;31(10)
Date
08/09/2017Pubmed ID
28787529DOI
10.1111/ctr.13070Scopus ID
2-s2.0-85030700179 (requires institutional sign-in at Scopus site) 17 CitationsAbstract
Arterial fistulas and pseudoaneurysms are rarely described significant arterial complications associated with pancreas transplantation that sometimes present with herald or catastrophic bleeding. We herein describe our institutional case series with a focus on management and outcomes. Of 2256 pancreas transplants, 24 arterial complications were identified in 23 recipients. Chart review was performed to describe the clinical characteristics, treatments, and outcomes of the complications (pseudoaneurysm, arterial enteric/cystic/ureteric fistula, or arteriovenous fistula). Of these 23 patients, 57% had a failed allograft at the time of the complication. Nine patients underwent primary surgical repair of 10 complications, 13 were treated by endovascular methods, and one patient by medical management. In total, 3 embolized patients rebled, 2 of which had failed allografts prior to treatment. Of those with graft function that were treated by embolization alone, all retained graft function. Diagnosis of arterial complications requires a high degree of suspicion and should involve early systemic angiography to evaluate the pancreatic vasculature. Management can be endovascular or surgical and should be individualized. We report our center's evolution from a predominantly surgical to endovascular approach as a definitive vs stabilizing therapy, with selective coiling mostly reserved for well-defined peripheral lesions in patients with a functioning allograft.
Author List
Yadav K, Young S, Finger EB, Kandaswamy R, Sutherland DER, Golzarian J, Dunn TBAuthor
Ty Blink Dunn MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultArteriovenous Fistula
Female
Follow-Up Studies
Graft Rejection
Graft Survival
Humans
Male
Middle Aged
Pancreas Transplantation
Postoperative Complications
Prognosis
Prospective Studies
Retrospective Studies
Risk Factors
Young Adult
