Allograft artery mycotic aneurysm after kidney transplantation: A case report and review of literature

BACKGROUND Allograft artery mycotic aneurysm (MA) represents a rare but life-threatening complication of kidney transplantation. Graftectomy is widely considered the safest option. Due to the rarity of the disease and the substantial risk of fatal consequences, experience with conservative strategies is limited. To date, only a few reports on surgical repair have been published. We describe a case of true MA successfully managed by aneurysm resection and arterial re-anastomosis. CASE SUMMARY An 18-year-old gentleman, on post-operative day 70 after deceased donor kidney transplantation, presented with malaise, low urinary output, and worsening renal function. Screening organ preservation fluid cultures, collected at the time of surgery, were positive for Candida albicans. Doppler ultrasound and contrastenhanced computer tomography showed a 4-cm-sized, saccular aneurysm of the iuxta-anastomotic segment of the allograft artery, suspicious for MA. The lesion was wide-necked and extended to the distal bifurcation of the main arterial branch, thus preventing endovascular stenting and embolization. After multidisciplinary discussion, the patient underwent surgical exploration, aneurysm excision, and re-anastomosis between the stump of the allograft artery and the internal iliac artery. The procedure was uneventful. Histology and microbiology evaluation of the surgical specimen confirmed the diagnosis of MA caused by Candida infection. Three years after the operation, the patient is doing very well with excellent allograft function and no signs of recurrent disease. CONCLUSION Surgical repair represents a feasible option in carefully selected patients with allograft artery MA. Anti-fungal prophylaxis is advised when preservation fluid cultures are positive

Vascular Laser and Light Treatments

This chapter provides an overview of vascular targeting light treatments applied to treatment of commonly encountered cutaneous vascular lesions, specifically port wine birthmarks (PWBs), infantile hemangiomas (IHs), and telangiectasias. Evidence-based recommendations are provided regarding light-based treatment effectiveness, preoperative evaluation, treatment techniques, safety, and postoperative management. We also discuss device and drug combinations which have been utilized including photodynamic therapy or laser in combination with antiangiogenic agents for PWBs and beta-blockers with lasers for IHs. This chapter provides a practical, concise, and evidence-based guide for the utilization of vascular-specific laser treatments available today

Intense Pulse Light (IPL)

Intense Pulsed Light (IPL) is a light-emitting system that is capable of emitting filtered polychromatic broad bandwidth wavelengths between 515 and 1,200 nm. The emission of wavelengths is controlled by both an internal filter that blocks undesired wavelengths from being emitted and a “heat-sink” effect that allows the controlled transfer of thermal energy from an object at high temperature to an object at lower temperature