Endovascular management of blunt renal artery trauma.

Mahmoud Abu-Gazala, Noam Shussman, Samir Abu-Gazala, Ram Elazary, Miklosh Bala, Shilo Rozenberg, Alexander Klimov, Avraham I Rivkind, Dan Arbell, Gidon Almogy, Allan I Bloom

Department of General Surgery and Trauma Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. mahmoudoski@yahoo.com

The Israel Medical Association journal : IMAJ 2013 May

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Renal artery injuries are rarely encountered in victims of blunt trauma. However, the rate of early diagnosis of such injuries is increasing due to increased awareness and the liberal use of contrast-enhanced CT. Sporadic case reports have shown the feasibility of endovascular management of blunt renal artery injury. However, no prospective trials or long-term follow-up studies have been reported. To present our experience with endovascular management of blunt renal artery injury, and review the literature. We conducted a retrospective study of 18 months at a level 1 trauma center. Search of our electronic database and trauma registry identified three patients with renal artery injury from blunt trauma who were successfully treated endovascularly. Data recorded included the mechanism of injury, time from injury and admission to revascularization, type of endovascular therapy, clinical and imaging outcome, and complications. Mean time from injury to endovascular revascularization was 193 minutes and mean time from admission to revascularization 154 minutes. Stent-assisted angioplasty was used in two cases, while angioplasty alone was performed in a 4 year old boy. A good immediate angiographic result was achieved in all patients. At a mean follow-up of 13 months the treated renal artery was patent in all patients on duplex ultrasound. The mean percentage renal perfusion of the treated kidney at last follow-up was 36% on DTPA renal scan. No early or late complications were encountered. Endovascular management for blunt renal artery dissection is safe and feasible if an early diagnosis is made. This approach may be expected to replace surgical revascularization in most cases.

Citation

Mahmoud Abu-Gazala, Noam Shussman, Samir Abu-Gazala, Ram Elazary, Miklosh Bala, Shilo Rozenberg, Alexander Klimov, Avraham I Rivkind, Dan Arbell, Gidon Almogy, Allan I Bloom. Endovascular management of blunt renal artery trauma. The Israel Medical Association journal : IMAJ. 2013 May;15(5):210-5