Iliac artery false aneurysm following renal allograft: presentation with non-specific inflammatory response and treatment by endovascular stent graft

A 41-year-old male received a cadaveric renal transplant 12 months after commencing haemodialysis. The allograft developed vascular occlusion requiring transplant nephrectomy. He was readmitted 15 days later with malaise and fever. He underwent evacuation of a haematoma from the wound. Three days later, there was evidence of further bleeding. He was found to have a defect in the donor patch that had become aneurysmal and to have an associated large retroperitoneal haematoma. The donor patch was trimmed and repaired with 5/0 prolene. Cultures taken from the artery grew Candida, which was treated with intravenous fluconazole. Patient review revealed erythropoetin resistance, persistently elevated C-reactive protein (CRP) 141 mg/l, and a low albumin 32 g/dl. He described intermittent sweats and pain in his right thigh. Patella tendon reflex was absent on the right side and he had an extensive area of numbness on the medial aspect of the right thigh. Computed tomography (CT) scanning demonstrated a large mass with an enhancing central lumen consistent with a false aneurysm (Figure 1). Diagnostic angiography confirmed the presence of a false aneurysm arising from the right external iliac artery (Figure 2). The lumen of the false aneurysm was treated successfully by placement of a stent graft (JoMed UK Ltd) across the arterial defect. The right internal iliac artery and distal run off were preserved (Figure 3). An ultrasound scan a week later showed reduction in size of the false aneurysm with no flow demonstrated on colour Doppler. The patient’s right lower limb neurological symptoms started to resolve and his inflammatory state also resolved. An ultrasound scan at 3 months shows a patent stent graft with no evidence of false aneurysm, and resolution of the right hydronephrosis.