Use of an extracorporeal bypass for renal preservation to treat a rare case of a true mycotic aneurysm in a renal transplant patient

True mycotic aneurysms of the abdominal aorta are extremely rare after organ transplantation. We report a renal transplant recipient who presented with Pseudomonas aeruginosa bacteremia and a new saccular infrarenal aortic aneurysm. A temporary extracorporeal axillofemoral bypass was placed to maintain perfusion to the transplant kidney. A contained rupture was found, and excision and in-line reconstruction were performed using a cryopreserved human aortic allograft. At 3 years, the patient remained well, with normal renal function while on oral antibiotic suppressive therapy. Use of an extracorporeal bypass was a viable technique with minimal morbidity for renal transplant preservation during open aortic replacement.