Case Report Common Iliac Artery Thrombosis following Pelvic Surgery Resulting in Kidney Allograft Failure Successfully Treated by Percutaneous Transluminal Angioplasty with Balloon-Expandable Covered Stent

We report the case of a 66-year-old woman who developed acute kidney allograft failure due to thrombotic occlusion of the common iliac artery after hysterectomy requiring emergent allograft rescue. She underwent percutaneous transluminal angioplasty with endovascular balloon expandable covered stent graft placement in the right common iliac artery. Although there are a handful of case reports of acute limb ischemia secondary to acute common iliac artery thrombosis, this is the first case reported in the literature resulting in successful kidney allograft rescue following pelvic surgery. Background Arterial thrombosis causing late acute kidney allograft failure is extremely rare. Pelvic or abdominal surgeries may place kidney allografts implanted in the pelvis at risk for injury Case Presentation A 66-year-old woman with end-stage renal disease in the setting of type-2 diabetes mellitus, hypertension, kidney stones, and renal artery stenosis had received an unrelated living-donor kidney transplant 7 years earlier. She also had a history of chronic obstructive pulmonary disease, coronary artery disease, heart failure with preserved left ventricular ejection fraction, and atrial fibrillation (on rivaroxaban, an orally active direct factor Xa inhibitor) for which she had undergone atrioventricular nodal ablation and insertion of a permanent pacemaker. She presented with excessive uterine bleeding. The workup demonstrated a pelvic mass and fluidfilled uterus. She underwent an elective hysteroscopy with dilation and curettage, which revealed pyometra. The intraoperative course was complicated by bleeding and uterine perforation requiring total abdominal hysterectomy and bilateral salpingooophorectomy. She lost 300 mL of blood and received intraoperatively 3.2 liters of crystalloids. There was no documented intraoperative hypotension. Pulses were equally palpable in both lower extremities before and after surgery. The patient developed anuria in the immediate postoperative period, and furosemide (40 mg) was administered intravenously with no response. The patient was reintubated for acute respiratory failure, and her anuria persisted. Investigations The urology service was initially consulted, and the patient underwent a cystoscopy with retrograde ureterogram, which revealed normal iodinated contrast filling and caliber o

Common Iliac Artery Thrombosis following Pelvic Surgery Resulting in Kidney Allograft Failure Successfully Treated by Percutaneous Transluminal Angioplasty with Balloon-Expandable Covered Stent

We report the case of a 66-year-old woman who developed acute kidney allograft failure due to thrombotic occlusion of the common iliac artery after hysterectomy requiring emergent allograft rescue. She underwent percutaneous transluminal angioplasty with endovascular balloon expandable covered stent graft placement in the right common iliac artery. Although there are a handful of case reports of acute limb ischemia secondary to acute common iliac artery thrombosis, this is the first case reported in the literature resulting in successful kidney allograft rescue following pelvic surgery