Transarterial Embolization for Renal Hemorrhage after Percutaneous Nephrolithotomy

Abstract

Percutaneous nephrolithotripsy (PNL) is a safe and effective treatment modality for the management of renal stones. This technique is associated with high success rates and few complications. The most important complication is hemorrhage. Delayed hemorrhage following PNL is rare complication and usually occurs due to development of the pseudoaneurysm or Arteriovenous fistula which can be successfully managed with arterial embolization. Here we are reporting a case of delayed post-PNL bleeding that occurred in a 41-year-old male operated on for renal stone. Multi Detector Computed Tomography scan revealed a presence of the pseudoaneurysm and Arteriovenous fistula in the inferior segmental branch of the left renal artery, which was successfully managed with amplatzer vascular plug.

Spontaneous Renal Artery Pseudoaneurysm Treated By Arterial Embolization

“…The incidence of renal artery pseudoaneurysm in patient with hypertension unresponsive to medical therapy can be as high as 39% ( 6) the etiologies of pseudoaneurysm are long standing untreated hypertension, surgical manipulation (open, laparoscopic, and/or endovascular) blunt and penetrating trauma, infectious angiomyolipomas (i.e., mycotic) ,polyarteritis nodosa , malignancy, radiation, and/or cyclophosphamide use (7,8). The risk of rupture is thought to vary inversely with size, and most investigators agree that an aneurysm exceeding 2 cm is more likely to undergo rupture and interventions are indicated in pseudoaneurysms greater than 2 cm, or when associated with complications such as severe hemorrhage and renovascular hypertension.…”