Vascular catastrophes following pancreas transplantation: An evolution in strategy at a single center

Jonathan A. Fridell, Matthew S. Johnson, William C. Goggins, Thiago Beduschi, Muhammad Mujtaba, Michelle L. Goble, John A. Powelson

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Introduction: Complications of pancreas transplantation involving the arterial anastomosis are potentially life threatening. In this report, we review our experience with such vascular catastrophes. Methods: Pancreas transplants performed between January 2003 and December 2009 were reviewed. All cases of pseudoaneurysm (PA) or arterioenteric fistula (AEF) were included. Results: Of 346 pancreas transplants, 10 vascular catastrophes in nine recipients were identified. There were five PAs, one involving the pancreas allograft, one involving the donor iliac artery Y-graft stump following allograft pancreatectomy, two involving the kidney allograft, and one involving the bifurcation of the Y-graft. The latter was treated with coil embolization, but subsequently developed into an AEF. There were five AEFs including the recipient mentioned above. Four had a failed allograft and three had discontinued immunosuppression. The final case had a clamp injury to the proximal common iliac artery that fistulized to the donor duodenum. The management, course and outcome of all nine recipients are described in detail. Conclusion: Vascular catastrophes such as PA and AEF are potentially life-threatening complications of pancreas transplantation. Immediate treatment at the time of bleeding is essential and covered stenting of the involved artery may provide immediate vascular control in these situations.

Original languageEnglish (US)
Pages (from-to)164-172
Number of pages9
JournalClinical Transplantation
Volume26
Issue number1
DOIs
StatePublished - Jan 2012
Externally publishedYes

Fingerprint

Pancreas Transplantation
Allografts
Blood Vessels
Fistula
Transplants
Pancreas
Iliac Artery
False Aneurysm
Pancreatectomy
Bleeding Time
Duodenum
Immunosuppression
Arteries
Kidney
Wounds and Injuries
Therapeutics

Keywords

  • Angiography
  • Arterioenteric fistula
  • Gastrointestinal bleeding
  • Pancreas transplantation
  • Pseudoaneurysm
  • Simultaneous kidney and pancreas transplantation
  • Stent
  • Vascular complications

ASJC Scopus subject areas

  • Transplantation

Cite this

Vascular catastrophes following pancreas transplantation : An evolution in strategy at a single center. / Fridell, Jonathan A.; Johnson, Matthew S.; Goggins, William C.; Beduschi, Thiago; Mujtaba, Muhammad; Goble, Michelle L.; Powelson, John A.

In: Clinical Transplantation, Vol. 26, No. 1, 01.2012, p. 164-172.

Research output: Contribution to journalArticle

Fridell, Jonathan A. ; Johnson, Matthew S. ; Goggins, William C. ; Beduschi, Thiago ; Mujtaba, Muhammad ; Goble, Michelle L. ; Powelson, John A. / Vascular catastrophes following pancreas transplantation : An evolution in strategy at a single center. In: Clinical Transplantation. 2012 ; Vol. 26, No. 1. pp. 164-172.
@article{dc2149235f494e30bdd3b6b8e6fcd90f,
title = "Vascular catastrophes following pancreas transplantation: An evolution in strategy at a single center",
abstract = "Introduction: Complications of pancreas transplantation involving the arterial anastomosis are potentially life threatening. In this report, we review our experience with such vascular catastrophes. Methods: Pancreas transplants performed between January 2003 and December 2009 were reviewed. All cases of pseudoaneurysm (PA) or arterioenteric fistula (AEF) were included. Results: Of 346 pancreas transplants, 10 vascular catastrophes in nine recipients were identified. There were five PAs, one involving the pancreas allograft, one involving the donor iliac artery Y-graft stump following allograft pancreatectomy, two involving the kidney allograft, and one involving the bifurcation of the Y-graft. The latter was treated with coil embolization, but subsequently developed into an AEF. There were five AEFs including the recipient mentioned above. Four had a failed allograft and three had discontinued immunosuppression. The final case had a clamp injury to the proximal common iliac artery that fistulized to the donor duodenum. The management, course and outcome of all nine recipients are described in detail. Conclusion: Vascular catastrophes such as PA and AEF are potentially life-threatening complications of pancreas transplantation. Immediate treatment at the time of bleeding is essential and covered stenting of the involved artery may provide immediate vascular control in these situations.",
keywords = "Angiography, Arterioenteric fistula, Gastrointestinal bleeding, Pancreas transplantation, Pseudoaneurysm, Simultaneous kidney and pancreas transplantation, Stent, Vascular complications",
author = "Fridell, {Jonathan A.} and Johnson, {Matthew S.} and Goggins, {William C.} and Thiago Beduschi and Muhammad Mujtaba and Goble, {Michelle L.} and Powelson, {John A.}",
year = "2012",
month = "1",
doi = "10.1111/j.1399-0012.2011.01560.x",
language = "English (US)",
volume = "26",
pages = "164--172",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - Vascular catastrophes following pancreas transplantation

T2 - An evolution in strategy at a single center

AU - Fridell, Jonathan A.

AU - Johnson, Matthew S.

AU - Goggins, William C.

AU - Beduschi, Thiago

AU - Mujtaba, Muhammad

AU - Goble, Michelle L.

AU - Powelson, John A.

PY - 2012/1

Y1 - 2012/1

N2 - Introduction: Complications of pancreas transplantation involving the arterial anastomosis are potentially life threatening. In this report, we review our experience with such vascular catastrophes. Methods: Pancreas transplants performed between January 2003 and December 2009 were reviewed. All cases of pseudoaneurysm (PA) or arterioenteric fistula (AEF) were included. Results: Of 346 pancreas transplants, 10 vascular catastrophes in nine recipients were identified. There were five PAs, one involving the pancreas allograft, one involving the donor iliac artery Y-graft stump following allograft pancreatectomy, two involving the kidney allograft, and one involving the bifurcation of the Y-graft. The latter was treated with coil embolization, but subsequently developed into an AEF. There were five AEFs including the recipient mentioned above. Four had a failed allograft and three had discontinued immunosuppression. The final case had a clamp injury to the proximal common iliac artery that fistulized to the donor duodenum. The management, course and outcome of all nine recipients are described in detail. Conclusion: Vascular catastrophes such as PA and AEF are potentially life-threatening complications of pancreas transplantation. Immediate treatment at the time of bleeding is essential and covered stenting of the involved artery may provide immediate vascular control in these situations.

AB - Introduction: Complications of pancreas transplantation involving the arterial anastomosis are potentially life threatening. In this report, we review our experience with such vascular catastrophes. Methods: Pancreas transplants performed between January 2003 and December 2009 were reviewed. All cases of pseudoaneurysm (PA) or arterioenteric fistula (AEF) were included. Results: Of 346 pancreas transplants, 10 vascular catastrophes in nine recipients were identified. There were five PAs, one involving the pancreas allograft, one involving the donor iliac artery Y-graft stump following allograft pancreatectomy, two involving the kidney allograft, and one involving the bifurcation of the Y-graft. The latter was treated with coil embolization, but subsequently developed into an AEF. There were five AEFs including the recipient mentioned above. Four had a failed allograft and three had discontinued immunosuppression. The final case had a clamp injury to the proximal common iliac artery that fistulized to the donor duodenum. The management, course and outcome of all nine recipients are described in detail. Conclusion: Vascular catastrophes such as PA and AEF are potentially life-threatening complications of pancreas transplantation. Immediate treatment at the time of bleeding is essential and covered stenting of the involved artery may provide immediate vascular control in these situations.

KW - Angiography

KW - Arterioenteric fistula

KW - Gastrointestinal bleeding

KW - Pancreas transplantation

KW - Pseudoaneurysm

KW - Simultaneous kidney and pancreas transplantation

KW - Stent

KW - Vascular complications

UR - http://www.scopus.com/inward/record.url?scp=84856657777&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84856657777&partnerID=8YFLogxK

U2 - 10.1111/j.1399-0012.2011.01560.x

DO - 10.1111/j.1399-0012.2011.01560.x

M3 - Article

C2 - 22129039

AN - SCOPUS:84856657777

VL - 26

SP - 164

EP - 172

JO - Clinical Transplantation

JF - Clinical Transplantation

SN - 0902-0063

IS - 1

ER -