Angio-Embolization of Renal Artery Pseudoaneurysm after Renal Biopsy: A Case Report

Abstract

Renal artery pseudoaneurysm is a rare clinical entity that has been reported after renal biopsy, percutaneous renal surgery, penetrating trauma, and rarely blunt renal trauma. We present the case of a 37-year-old man with ruptured renal artery pseudoaneurysm accompanied by massive gross hematuria, urinary clot retention, and bladder tamponade, which were the presenting signs seven hours after renal biopsy. Abdominal CT scan showed a large perinephric, intracapsular hematoma of left kidney. His angiogram revealed a left renal segmental artery pseudoaneurysm that measured 1 cm × 1 cm. He was successfully treated by selective embolization of the arterial branch supplying the pseudoaneurysm.

A Rare Case of Spontaneous Asymptomatic Renal Artery Pseudoaneurysm Treated with Coil Embolization: A Case Report

“…Signs and symptoms of RAP may develop immediately after the insult or they may be delayed. 6 Hematuria is the most common symptom associated with RAP and results from the erosion of RAP into the adjacent renal collecting system; this may occur within 2 to 4 weeks after the injury. 7 A metaanalysis including 13 studies of partial nephrectomy, which included a total of 105 patients with RAP, showed that 102 (97%) patients were symptomatic at presentation.…”

“…7 In general, angiographic embolization is the procedure of choice for management of RAP due to its minimally invasive and selective nature and the maximal preservation of renal parenchyma. 6 Renal artery embolization begins with a renal angiogram through a transfemoral approach. Selective embolization of renal artery branches can be achieved by using microcatheters inserted coaxially over a guidewire.…”

Incidental renal artery pseudoaneurysm after percutaneous native renal biopsy

“…Signs and symptoms of the RAP may develop immediately after the insult or they may be delayed 3. Mima et al 3 reported a case in which massive haematuria, urinary clot rentention and bladder tamponade 7 h after the percutaneous renal biopsy were the presenting signs of RAP.…”

“…Signs and symptoms of the RAP may develop immediately after the insult or they may be delayed 3. Mima et al 3 reported a case in which massive haematuria, urinary clot rentention and bladder tamponade 7 h after the percutaneous renal biopsy were the presenting signs of RAP. Haematuria is the most common symptom associated with RAPs and results from erosion of the RAP into the adjacent renal collecting system9; this may occur within 2–4 weeks after the injury.…”

“…Surgical indications for repair include overt ruptures, an aneurysm greater than 2 cm, renovascular hypertension, expansion of the aneurysm and evidence of renal damage 9. In general, angiographic embolisation is the procedure of choice due to its minimally invasive and selective nature and the maximal preservation of renal parenchyma 3. However, embolisation for the management of RAP appears to have some shortcomings, such as possible reflux of embolic material into the normal proximal vessel if the distal branch has not been selectively cannulated and the risk of more generalised ischaemia resulting from thrombosis of a main feeding branch 9 11.…”