Pseudoaneurysm of the superior mesenteric artery with an arteriovenous fistula after simultaneous kidney-pancreas transplantation

Vascular complications remain a significant source of morbidity after pancr eatic transplantation. We describe a pseudoaneurysm of the superior mesente ric artery (SMA) with an arteriovenous fistula (AVF) involving the SMA and the superior mesenteric Vein (SMV) discovered and treated surgically in the second week after kidney-pancreas transplantation. The patient experienced pain over the graft, and subsequent radionuclide and Doppler ultrasound sc an were suggestive of a pseudoaneurysm in the head of the pancreas. Awaitin g confirmatory angiography, the patient became hypotensive and after resusc itation, underwent emergency surgery when a pseudoaneurysm was found in the head of the pancreas. After looping the proximal and distal recipient ilia c artery and base of the donor Y vascular graft, the AVF was separated and ligated. The SMV was dissected off the pancreatic head and repaired over a tamponading intraluminal Foley catheter. Graft function was preserved. Base d on this experience, an AVF with or without a pseudoaneurysm in the pancre as allograft should be corrected as soon it is suspected.