An Innovative Endovascular Approach to Pancreatic Transplant Artery Y-Graft Aneurysm Complications Using Elective Endovascular Techniques: A Case Report.

Abstract

BACKGROUND Pancreatic transplant is the only definitive treatment to restore normoglycemia for autoimmune type 1 diabetes, but it is associated with significant morbidity due to its complexity from the index operation and sequelae. Vascular complications, including thrombosis and pseudoaneurysms, can have significant impacts on pancreatic transplant graft function. CASE REPORT Pancreatic transplant artery aneurysm is a rare complication of pancreas transplant. Vascular complications of transplants, including aneurysm rupture, are life-threatening and can require transplant pancreatectomy. We present a rare case of a chronic pancreatic transplant Y-graft arterial pseudoaneurysm of unknown etiology, 20 years after the initial simultaneous pancreas and kidney transplant. Due to the chronicity, previous significant adhesiolysis from a cholecystectomy, unlikelihood of a mycotic aneurysm, and concern for thrombus propagation leading to graft dysfunction, an endovascular approach was used. A combination of covered endovascular stents was deployed to maintain adequate blood flow to the pancreas allograft. Following endovascular Y-stenting, the patient maintained pancreatic graft function with no signs of allograft rejection. CONCLUSIONS Endovascular stenting can be used to treat chronic transplant pancreatic artery aneurysms and offers a less invasive treatment alternative to open surgery.