Periarterial papaverine to treat renal artery vasospasm during robot-assisted laparoscopic partial nephrectomy

Abstract

Renal artery vasospasm can be a troublesome complication during robot-assisted laparoscopic partial nephrectomy. Urologists performing this procedure, especially if utilizing selective arterial vascular microdissection, should be aware of using papaverine for both prevention and treatment of renal artery vasospasm. We present a 33-year-old male who developed severe renal artery vasospasm just with hilar dissection causing the kidney to become ischemic. Papaverine was topically applied on the renal arteries resulting in vasodilation and reperfusion of the kidney. Our objective of this report is to raise awareness of this complication as well as to review the literature on periarterial papaverine use and the dosing for topical applications.

Ex Vivo Open Reconstruction of Hilar Renal Artery Aneurysms: A Single-Center Experience

“…The first step is the nephrectomy, and in our series a total or hand-assisted laparoscopic technique was adopted in order to reduce the invasiveness of this approach. In this regard, since pneumoperitoneum reduces renal blood flow, it is important to keep the patient wellhydrated, and a topical application of papaverine on the renal artery to prevent vasospasm may be considered [20].…”

Papaverine use for radial artery sheath entrapment

“…After bolus injection, it exhibits a rapid onset of action; however, the vasodilation is not very prolonged (lasting approximately 2 min). Few studies have described the use of papaverine as a vasodilator drug, for example, for preventing arterial spasm in bypass grafting and renal artery spasm in laparoscopic surgery; however, only one case report has described the use of papaverine to resolve catheter entrapment due to severe radial artery spasm (7)(8)(9)(10).…”