病毒感染後產生之移植腎動脈假性動脈瘤支架血栓 - 罕見案例報告

楊浩誌、劉昱良、黃國財、林健煇、林威宇、陳志碩、黃雲慶、何東儒

財團法人嘉義長庚紀念醫院 外科部 泌尿科

Viral-Related Stent Thrombosis In The Transplant Renal Artery Stent Which For Anastomotic Pseudoaneurysm – A Rare Case Report

Hao-Chih Yang, Yu-Liang Liu, Kuo-Tsai Huang, Jian-Hui Lin, Wei-Yu Lin, Chih-Shou Chen, Yun-Ching Huang, Dong-Ru Ho

Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan

Introduction:

  Anastomotic pseudoaneurysm formation in renal transplant recipients is a rare complication, with a prevalence of less than 1%. Despite its rarity, this condition can be devastating, leading to significant consequences such as graft functional impairment, graft loss, or even mortality. There is no standardized treatment approach, with options including open surgical repair using saphenous vein grafts, kidney transplantectomy, endovascular repair, coil embolization, and, in some cases, active surveillance.

  This report aims to highlight the clinical decision-making process and provide a review of the existing literature on managing this rare yet severe complication.

Case presentation:

  In this case report, we present a 50-year-old renal transplant recipient who developed an anastomotic pseudoaneurysm one month later. The patient underwent successful endovascular repair with stenting, ultimately preserving graft function.

  However, fifteen months later, the thrombus formation over the stent with renal function impaired was noted, then he accepted temporary hemodialysis and contact CV surgeon for embolectomy and percutaneous transluminal angioplasty (PTA) to rescue the graft.

  Notably, the patient reported a Herpes Zoster infection approximately two weeks prior to the onset of symptoms, potentially contributing to the thrombotic event.

Conclusion:

  This case demonstrates the rare but serious complication of anastomotic pseudoaneurysm and subsequent stent thrombosis in a renal transplant recipient, highlighting the need for vigilant monitoring in the post-transplant period.

  The patient’s viral infection with Herpes Zoster likely contributed to thrombus formation in the stent, underscoring the importance of recognizing infection-related prothrombotic risks, particularly in immunocompromised patients.

  The case highlights the importance of a multidisciplinary approach and individualized decision-making in the management of such complex post-transplant vascular complications.