De novo renal artery aneurysm presenting 6 years after transplantation: A complication of recurrent arterial stenosis? Shelby H. Burkey, MD, Miguel A.

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Presentation transcript:

De novo renal artery aneurysm presenting 6 years after transplantation: A complication of recurrent arterial stenosis? Shelby H. Burkey, MD, Miguel A. Vazquez, MDa, R.James Valentine, MD Journal of Vascular Surgery Volume 32, Issue 2, Pages 388-391 (August 2000) DOI: 10.1067/mva.2000.106943 Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 Stenosis (arrow ) in the proximal segment of the donor renal artery. Journal of Vascular Surgery 2000 32, 388-391DOI: (10.1067/mva.2000.106943) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 Recurrent stenosis (arrow ) at the renal artery– hypogastric artery anastomosis. In this projection, the stenosis appears directly behind the external iliac artery. Journal of Vascular Surgery 2000 32, 388-391DOI: (10.1067/mva.2000.106943) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 Arteriogram of renal transplant demonstrating large renal artery aneurysm at the bifurcation of the main renal artery. Journal of Vascular Surgery 2000 32, 388-391DOI: (10.1067/mva.2000.106943) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 Illustration depicting operative technique. A, The location of the aneurysm was clearly separate from the previous anastomoses. B, Opened aneurysm demonstrated involvement of the upper and lower pole branch orifices. Shaded area is the location of proximal anastomosis for the vein graft. C, Reconstructed renal artery. The saphenous vein graft incorporated the lower pole and main trunk in the proximal anastomosis. The distal anastomosis was created end-to-end with the upper pole branch. Journal of Vascular Surgery 2000 32, 388-391DOI: (10.1067/mva.2000.106943) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 Postoperative arteriogram demonstrating completed repair. Journal of Vascular Surgery 2000 32, 388-391DOI: (10.1067/mva.2000.106943) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 6 Hematoxylin-eosin stain. Photomicrograph of aneurysm wall demonstrating presence of all layers of the arterial wall. A, Adventitia; I, intima; M, media. Journal of Vascular Surgery 2000 32, 388-391DOI: (10.1067/mva.2000.106943) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 7 Elastic stain. Photomicrograph of aneurysm wall at the proximal neck area demonstrating disrupted internal and external elastic lamina. Arrow indicates area of disrupted internal elastic lamina. E, External elastic lamina; I, internal elastic lamina. Journal of Vascular Surgery 2000 32, 388-391DOI: (10.1067/mva.2000.106943) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions