A Case of External Iliac Artery Injury during Simultaneous Pancreas-Kidney Transplantation Successfully Managed with Resuscitative Endovascular Balloon Occlusion of the Aorta.

INTRODUCTION: Simultaneous pancreas-kidney transplantation (SPK) is an established treatment for patients with type 1 diabetes mellitus complicated by end-stage renal disease. In retransplantation cases, removal of the existing graft may be required, and severe adhesions around the graft increase the risk of vascular injury. In particular, bleeding from deep vessels can be difficult to control because vascular exposure and clamping are often challenging.

CASE PRESENTATION: A 45-year-old woman with end-stage renal disease secondary to type 1 diabetes mellitus had previously undergone living-donor kidney transplantation. The graft function deteriorated due to treatment-resistant rejection, and she was scheduled for SPK after receiving a deceased donor organ. During removal of the existing renal graft in the left iliac fossa, the external iliac artery was injured, resulting in uncontrolled arterial bleeding that could not be managed by compression, suturing, or vascular clamping. A resuscitative endovascular balloon occlusion of the aorta (REBOA) catheter was inserted via the left femoral artery and used for temporary blood flow control of bleeding from the injured external iliac artery. This stabilized both the hemodynamics and the operative field, allowing successful suture repair of the arterial injury. Subsequently, kidney and pancreas transplantation were completed. The postoperative course was uneventful.

CONCLUSIONS: In SPK with retransplantation, vascular injury may occur during graft removal. Temporary blood flow control using REBOA may be a useful strategy for achieving hemostasis and securing the operative field in cases of localized arterial injury.