Endovascular treatment of renal arterial perforation after blunt trauma: Case report. (2018)

• Record Type: Journal Article
• Authors: Lim, Kyoung Hoon; Ryeom, Hun Kyu; Park, Jinyoung
• Is Part Of: International journal of surgery case reports. Volume 42(2018)
• Page Start: 208
• Page End: 211
• Publication Date: 2018
• Subjects: Renal artery -- Perforation -- Trauma -- Endovascular -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2017.11.069
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: A blunt renal arterial injury commonly leads to thrombotic occlusion, but only rarely to an isolated arterial perforation. The surgical approach of perforated renal arteries is likely to be an extensive operation. An endovascular treatment may be a better way to prevent postoperative morbidities. Endovascular treatment of a perforated renal artery is feasible, and obviates the need for a laparotomy with general anesthesia. Abstract: Introduction: Isolated renal arterial perforation is a rare consequence of blunt abdominal trauma. Meticulous surgical control of retroperitoneal active bleeding is difficult due to oozing of soft connective tissue, the deep position of operative field, and the presence of friable vascular tissue. Therefore, endovascular treatment is often preferred. Presentation of case: An 83-year-old man was transferred to our trauma center due to retroperitoneal active bleeding after a car accident, in which his right upper abdomen struck the steering wheel. Contrast-enhanced abdominal computed tomography (CT) showed a retroperitoneal hematoma behind the inferior vena cava and contrast medium extravasation on the medial side of the right kidney. Selective right renal arteriography confirmed a perforation in the proximal right main renal artery, approximately 3 cm from the ostium. We successfully placed a covered stent across the perforation site. Discussion: Endovascular management may reduce the likelihood of extensive abdominal surgery, surrounding organ damage, risk of bleeding, and postoperative morbidity. We regarded embolization as inappropriate for kidney salvage in our patient, and therefore used a self-expanding covered stent to treat the perforation. Conclusion: Endovascular management of a traumatic renal arterial injury is the best approach to preserve renal function in hemodynamically stable patients who cannot tolerate laparotomy, due to risks associated with general anesthesia, and who can tolerate anticoagulation therapy.