Endovascular management of giant common iliac artery pseudoaneurysm after complications in simultaneous pancreas–kidney transplant: a case report

BACKGROUND: Pancreatic transplantation is a definitive treatment for selected patients with insulin-dependent diabetes. It is a technically challenging surgery, and vascular complications are the most common cause of pancreatic graft failure. Although rare, pancreas transplants present higher rates of pseudoaneurysms at the vascular anastomosis than other visceral transplants. We present a case of a simultaneous pancreas–kidney transplant complicated with graft failure and common iliac artery pseudoaneurysm that was successfully treated through endovascular techniques. CASE PRESENTATION: A 34-year-old White woman presented with abdominal pain and a history of type 1 diabetes mellitus, end-stage renal disease, and two previous pancreas transplantation failures. The first was a simultaneous pancreas–kidney transplantation performed 7 months prior that was complicated by pancreas graft thrombosis within 1 month and required graft resection. Five months later, she underwent a second pancreas transplantation with another pancreatic graft thrombosis requiring graft resection. Abdominal angiotomography revealed a pseudoaneurysm in the right common iliac artery at the point of the previous graft anastomosis. The patient was successfully treated endovascularly with a covered stent in the common iliac artery. CONCLUSION: Stent graft implantation for the treatment of common iliac artery pseudoaneurysm as a complication of simultaneous pancreas–kidney transplantation is a safe and feasible procedure.