Renal artery pseudoaneurysm after blunt renal trauma: report on three cases and review of the literature

Abstract

CONTEXT: Renal artery pseudoaneurysm is a rare complication after renal injury but should be suspected whenever there is recurrent hematuria after renal trauma. CASE REPORTS: We present three cases of pseudoaneurysm after blunt renal trauma and a review of the literature. All patients underwent renal angiography. Two cases were diagnosed during the initial hospital stay due to hematuria, or in the follow-up period during recovery. One patient was hemodynamically unstable. Two patients successfully underwent coil embolization in a single session. In the other case, selective embolization was attempted, but was unsuccessful because artery catheterization was impossible. Procedural and medical success and complications were retrospectively assessed from the patients' records. The clinical presentation, treatment options and clinical decisions are discussed. CONCLUSIONS: Renal artery pseudoaneurysm may develop acutely or even years after the initial injury. Signs and symptoms may have a wide spectrum of presentation. Selective angiographic embolization is an effective treatment that reduces the extent of parenchymal infarction.RESUMO CONTEXTO: Pseudoaneurisma de artéria renal é uma complicação rara após lesão renal, mas deve ser suspeitada quando houver hematúria recorrente após trauma renal. RELATO DE CASOS: Três casos de pseudoaneurisma após trauma renal fechado são apresentados, além de revisão da literatura. Todos os pacientes foram submetidos a angiografia renal. Dois dos casos foram diagnosticados durante a estadia hospitalar inicial, por hematúria ou no período de acompanhamento durante a recuperação. Um paciente estava hemodinamicamente instável. Dois pacientes foram submetidos a embolização com coil com sucesso em uma única sessão. No outro caso, a embolização seletiva foi tentada sem sucesso, devido à impossibilidade de cateterização da artéria. O sucesso médico e do procedimento e as complicações foram retrospectivamente avaliados a partir dos registros dos pacientes. A apresentação clínica, opções de tratamento e decisões clínicas são discutidas. CONCLUSÕES: Pseudoaneurisma de artéria renal pode se desenvolver agudamente ou até mesmo anos após o trauma inicial. Sinais e sintomas podem ter um amplo espectro de apresentação. Embolização angiográfica seletiva é um tratamento efetivo, reduzindo a extensão de infarto parenquimatoso.

Intraparenchymal Renal Artery Pseudoaneurysm and Arteriovenous Fistula on a Solitary Kidney Occurring 38 Years after Blunt Trauma

“…They are of mixed origin and may be congenital, posttraumatic and iatrogenic, or associated with systemic diseases such as neoplasms or polyarteritis nodosa. They have most commonly been reported in relation to iatrogenic causes such as open or percutaneous surgery or biopsy [10] and are exceedingly rare after a nonpenetrating trauma. Most of them are asymptomatic.…”

“…Blood flows under pressure from the renal artery and pushes the surrounding renal parenchyma open, creating a cavity varying in size and shape [10]. Fistulae are generally caused by a penetrating trauma but can also have a congenital or idiopathic origin.…”

Can we predict delayed undesirable events after blunt injury to the torso visceral organs?

“…Although renal artery pseudoaneurysm is also rare, Yamaçake et al 15. reported in a case report series that it was possible for a pseudoaneurysm to develop from blunt renal trauma even years after the initial injury.…”

Blunt abdominal trauma. Kidneys injury. Part 3

“…P. Aguayo и соавт. [10] не считают гематурию фактом, ограничивающим срок выписки, хотя со-храняющаяся или рецидивирующая макрогемату-рия, по мнению лектора и других авторов [108], -это настораживающий симптом.…”

“…Ложная посттравматическая артериальная анев-ризма [52,108] и артериовенозный свищ [102] явля-ются чрезвычайно редкими осложнениями консер-вативной терапии и требуют применения эндова-скулярных методов лечения.…”