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

Yamaçake, Kleiton Gabriel Ribeiro; Lucon, Marcos; Lucon, Antonio Marmo; Mesquita, José Luiz Borges; Srougi, Miguel

doi:10.1590/1516-3180.2013.1315488

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Sao Paulo Medical Journal

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Sumário

Case Report • Sao Paulo Med. J. 131 (05) • 2013 • https://doi.org/10.1590/1516-3180.2013.1315488 copy

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

Pseudoaneurisma de artéria renal após trauma renal fechado: relato de três casos e revisão da literatura

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Hematuria; Renal artery; Wounds, nonpenetrating; Aneurysm; Embolization, therapeutic

Database	Strategy	Related
Embase (via Ovid)	False aneurysm AND Renal artery AND Blunt trauma	Case reports: 11
		Descriptive series: 1
		Articles: 3
Medline (via Pubmed)	(("Aneurysm, False" [MeSH]) OR (Pseudoaneurysm) OR (Pseudoaneurysms)) AND ("Renal Artery"[Mesh]) AND (("Wounds, Nonpenetrating"[Mesh]) OR (Blunt Trauma) OR (Blunt Renal Trauma))	Case reports: 15
		Articles: 2
		Descriptive series: 1
Lilacs (via Bireme)	(Aneurysm False) OR ( Aneurisma falso) OR Pseudoaneurysm OR Pseudoaneurysms OR Pseudoaneurismas AND (Renal Artery) OR (Artéria Renal) OR (Arteria renal) AND (Wounds, Nonpenetrating) OR (Blunt Trauma) OR (Blunt Renal Trauma) OR (Ferida não penetrante) OR (Trauma Renal) OR (Heridas non penetrantes)	No results

Author	Age	GenderMale (M) Female (F)	Time between trauma and diagnosis	Diagnosis during hospital stay	Trauma location	Symptoms at diagnosis	Therapy	Result	Blood pressure	Creatinine	Follow-up
Chuang et al.¹⁷	35	M	7 days	Yes	Not reported	Gross hematuria and abdominal pain	Selective injection	Nephrectomy	Not reported	Not reported	Not reported
Lieberman et al.¹⁸	21	M	< 4 days	Yes	Left flank	Flank pain and gross hematuria	Gelatin sponge	Renal infarction	Not reported	Not reported	Not reported
Testart et al^.19	54	M	36 months	No	Not reported	Abdominal pain	Bypass	Renal salvage	Not reported	Not reported	Not reported
Aburano et al.²⁰	79	M	21 days	No	Not reported	Gross hematuria	Nephrectomy	Nephrectomy	Not reported	Not reported	Not reported
Steffens et al.³³	15	M	12 days	Yes	Left flank	Gross hematuria	Embolization (2 x)	Renal salvage and 2nd embolization one year later	Normal	Normal	36 months
Swana et al.²	49	F	45 days	No	Not reported	Flank pain	Embolization	Renal salvage	Not reported	Not reported	Not reported
Farrel et al.³	27	M	9 days	Yes	Not reported	Hematuria	Not reported	Not reported	Not reported	Not reported	Not reported
Jebara et al.²¹	25	F	15 years	No	Not reported	Hypertension	Not reported	Not reported	Not reported	Not reported	Not reported
Jebara et al.²¹	17	F	8 years	No	Right flank	Abdominal pain	Not reported	Not reported	Not reported	Not reported	Not reported
Han et al.⁷	50	M	21 days	No	Right flank	Gross hematuria and hypertension	Not reported	Not reported	Not reported	Not reported	Not reported
Mizobata et al.²²	40	F	10 days	Yes	Left flank	Not reported	Embolization	Renal salvage	Not reported	Not reported	Not reported
Mizobata et al.²²	27	M	56 days	Yes	Back	Not reported	Embolization	Renal salvage	Not reported	Not reported	Not reported
Dinkel et al.²³	28	F	8 days	Not reported	Not reported	Gross hematuria	Embolization	Renal salvage	Normal	Normal	2 years
Dinkel et al.²³	34	F	3 years	Yes	Left flank	Gross hematuria	Embolization	Renal salvage	Normal	Normal	3 months
Dinkel et al.²³	20	M	5 days	Not reported	Right flank	Gross hematuria	Embolization	Renal salvage	Normal	Normal	4 years
Dinkel et al.²³	32	M	8 days	Not reported	Not reported	Gross hematuria	Embolization	Renal salvage	Normal	Normal	4 months
Miller et al.⁴	44	M	8 days	Yes	Not reported	Gross hematuria	Embolization	Renal salvage	Normal	Normal	3 months
Lee et al.¹	32	M	18 days	No	Left flank	Gross hematuria	Embolization	Renal salvage	Normal	Normal	11 months
Lee et al.¹	42	M	11 days	No	Left flank	Gross hematuria	Embolization	Renal salvage	Normal	Normal	9 months
Lee et al.¹	38	M	45 days	No	Left flank	None (lesion discovered at follow-up by means of computed tomography)	Embolization	Renal salvage
Lee et al.¹	26	M	1 day	Yes	Abdomen	Shock	Laceration repair on post-injury day 1	Nephrectomy	Normal	Normal	6 months
Lee et al.¹	24	M	1 day	Yes Diagnosis after surgery	Abdomen	Gross hematuria	Laceration repair on post-injury day 1 and embolization on post-injury day 2	Renal salvage	Normal	Normal	5 months
Halachmi et al.²⁴	11	M	7 days	Yes	Left flank	Gross hematuria	Embolization	Renal salvage	Normal	Normal	1 month
Giannopoulos et al.²⁵	25	M	7 days	Yes	Back	Gross hematuria and back pain	Embolization	Renal salvage	Not reported	Not reported	Not reported
Chatziioannou 2004²⁶	23	M	1 day	Yes	Not reported	Hematuria	Embolization	Renal salvage	Normal	Normal	23 months
Saad et al.¹²	11	F	21 days	No	Right flank	Hematuria	Embolization	Renal salvage	Not reported	Not reported	Not reported
Lee et al.⁸	52	M	21 days	Yes	Not reported	Microscopic hematuria and flank pain			Not reported	Not reported	Not reported
Poulakis et al.²⁷	24	M	60 days	No	Not reported	Microscopic hematuria and flank pain	Embolization	Renal salvage	Not reported	Normal	6 months
Guerra Requena et al.²⁸	51	M	16 months	No	Not reported	Flank pain	Angiography: unsuccessful	Open surgery suture, renal salvage	Not reported	Not reported	Not reported
Pastorín 2007²⁹	25	M	4 months	No	Abdomen	None	Embolization	Renal salvage	Normal	Normal	3 months
Rashid et al.⁶	49	F	49 days	No	Not reported	Gross hematuria			Not reported	Not reported	Not reported
Garg et al.³⁰	30	M	9 years	No	Right flank	Gross hematuria	Embolization: unsuccessful	Renal salvage	Not reported	Not reported	Not reported
Lindekleiv et al.³¹	58	M	9 yeas	No	Right flank	Gross hematuria and flank pain	Embolization: unsuccessful	Nephrectomy	Not reported	Not reported	Not reported
Steinway et al.³²	19	M	16 days	No	Abdomen	Gross hematuria	Embolization: unsuccessful	Nephrectomy	Not reported	Not reported	Not reported
Jackson et al.³⁴	59	M	16 days	No	Abdomen	Gross hematuria and flank pain	Embolization	Renal salvage	Not reported	Not reported	6 months

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[1] Address for correspondence: Kleiton Gabriel Ribeiro Yamaçake Rua Professor Serafim Orlandi, 308 Vila Mariana - São Paulo (SP) - Brasil CEP 04115-090 Tel. (+55 11) 2661-8080 Fax. (+55 11) 2661-8081 E-mail: kleiton_med91@yahoo.com.br