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Choi MJ, Kim PH, Shin JH, Kim JW, Gwon DI, Kim JH, Ko GY, Yoon HK, Ohm JY. Angiographic management of percutaneous renal procedure-related bleeding: A single-center experience. Int J Urol 2018; 26:406-412. [PMID: 30575138 DOI: 10.1111/iju.13891] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 11/26/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To present the radiological and clinical results of transcatheter arterial embolization in patients with active bleeding after percutaneous renal procedures. METHODS A total of 79 consecutive patients who underwent angiography for percutaneous renal procedure-related bleeding were included in the present retrospective analysis. Patient characteristics, angiographic management and clinical outcomes were analyzed. RESULTS On angiography, bleeding foci were observed in 81.0% of the patients (64/79), all of whom underwent transcatheter arterial embolization. Among the 15 patients (19.0%) with negative angiographic findings, empirical transcatheter arterial embolization was carried out in six patients (40.0%). The technical success rate in 64 patients with positive angiographic findings was 100%, and the clinical success rate in 70 patients who underwent transcatheter arterial embolization was 85.7% (60/70). A total of 14.3% (10/70) of patients with clinical failure underwent repeat transcatheter arterial embolization and all achieved clinical recovery. There were no major complications. There was no statistical difference in estimated glomerular filtration rate values before the percutaneous renal procedure and those measured 7 days after transcatheter arterial embolization (43.4 ± 24.4 to 44.6 ± 25.1 mL/min/1.73 m2 ; P = 0.189). Clinical failure was not associated with age, sex, type of renal procedures, bleeding tendency, presence of active bleeding on angiography, latency time and embolic agents used (P > 0.05). CONCLUSIONS Transcatheter arterial embolization is a safe and effective method of treating percutaneous renal procedure-related bleeding without renal function deterioration.
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Affiliation(s)
- Min Jeong Choi
- Department of Radiology, Dankook University Hospital, Cheonan, Korea
| | - Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Jong Woo Kim
- Department of Radiology and Research Institute of Radiology, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, College of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Joon Young Ohm
- Department of Radiology, Chungnam National University Hospital, Daejeon, Korea
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Li Q, Lin X, Zhang X, Samir AE, Arellano RS. Imaging-Related Risk Factors for Bleeding Complications of US-Guided Native Renal Biopsy: A Propensity Score Matching Analysis. J Vasc Interv Radiol 2018; 30:87-94. [PMID: 30527649 DOI: 10.1016/j.jvir.2018.08.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/24/2018] [Accepted: 08/30/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate imaging-related hemorrhagic risk factors for ultrasound (US)-guided native kidney biopsy. MATERIALS AND METHODS A retrospective review was conducted of adult patients who underwent US-guided native kidney biopsy at a single center between January 2006 and March 2016 and identified 37 of 551 patients (6.72%) with postbiopsy bleeding complications, including 11 major complications (2.00%; n = 11) and 26 minor complications (4.72%; n = 26). Ten patients with major complications and 20 with minor complications were matched with 20 control subjects each by propensity score matching based on age, needle size, number of cores, blood pressure, partial thromboplastin time, prothrombin time, platelet count, and estimated glomerular filtration rate. RESULTS Biopsy needle passing through the renal sinus was identified in the patients with major (6 of 10; 60%) and minor complications (8 of 20; 40.0%) but not in the control groups. For patients with major complications, the needle-sinus distance was significantly shorter (5.11 mm ± 7.32 vs 11.14 mm ± 3.54; P = .023) and the needle-capsule distance was significantly longer (17.52 mm ± 8.04 vs 9.28 mm ± 3.29; P = .0004) than in control subjects. The bimodal distribution of cortical tangential angles (< 30° or ≥ 60°) in minor complication cases (17 of 20; 85.0%) was significantly greater than in the control group (8 of 20; 40.0%; odds ratio = 8.50; P = .004). CONCLUSIONS This study identifies imaging risk factors in US-guided native kidney biopsy and recommends an algorithm to manage them, including appropriate needle path position between the renal capsule and sinus and proper needle cortical tangential angle.
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Affiliation(s)
- Qian Li
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 293, Boston, MA 02114
| | - Xueying Lin
- Department of Ultrasound, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xi Zhang
- Clinical Research Unit, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Anthony E Samir
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 293, Boston, MA 02114
| | - Ronald S Arellano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 293, Boston, MA 02114; Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., GRB 293, Boston, MA 02114.
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3
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Devi BV, Lakshmi BS, Supraja C, Vanajakshmma V, Ram R, Rajasekhar D, Lakshmi AY, Sivakumar V. Hemorrhage from lumbar artery following percutaneous renal biopsy. Indian J Nephrol 2015. [PMID: 26199475 PMCID: PMC4495478 DOI: 10.4103/0971-4065.158174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We present a 58-year-old lady who underwent ultrasound-guided renal biopsy for suspected acute glomerulonephritis. Within minutes, the radiologist noticed an echogenic band around left kidney and in the muscular planes. Computerized tomography revealed focal active contrast extravasation from arcuate or interlobular artery in lower pole of left kidney and lumbar artery at third lumbar vertebra. The bleeding vessel was occluded with gelfoam.
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Affiliation(s)
- B Vijayalakshmi Devi
- Department of Radiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - B Sangeetha Lakshmi
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - C Supraja
- Department of Radiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - V Vanajakshmma
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - R Ram
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - D Rajasekhar
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - A Y Lakshmi
- Department of Radiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - V Sivakumar
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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Ikeda O, Kawanaka K, Nakasone Y, Tamura Y, Yamashita Y. Direct percutaneous embolization of an iatrogenic lumbar artery pseudoaneurysm following unsuccessful coil embolization. Acta Radiol 2012; 53:541-4. [PMID: 22527537 DOI: 10.1258/ar.2012.110210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A 56-year-old man with acute myeloleukemia was hospitalized for lumbar pain. Treatment with antibiotics failed to improve the symptoms. For the diagnosis of infiltration by leukemia we performed CT-guided percutaneous needle biopsy of the L2-L3 disc and the L3 vertebral body using a left posterolateral approach. His symptoms were improved by treatment with antibiotics and he was discharged 4 days later. He again experienced lumbar pain 4 days post-discharge and was readmitted. Unenhanced CT scans of the abdomen and pelvis revealed a giant hematoma in the left psoas muscle and we suspected lumbar arterial injury. A preoperative aortography and transcatheter arterial coil embolization was then performed for the diagnosis and treatment of a lumbar artery pseudoaneurysm. On the preoperative angiography, pseudoaneurysm arising from the left lumbar artery was shown. All feeders were shown by the selective catheterization of the lumbar arteries and they were completely embolized using coils. However, contrast-enhanced CT obtained on the next day still demonstrated a pseudoaneurysm in the left psoas muscle. Thus, additional percutaneous embolization using N-butyl-2-cyanoacrylate was performed. After this procedure, complete embolization of the pseudoaneurysm was obtained and his lumbar pain was relieved.
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Affiliation(s)
- Osamu Ikeda
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Kumamoto, Japan
| | - Koichi Kawanaka
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Kumamoto, Japan
| | - Yutaka Nakasone
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Kumamoto, Japan
| | - Yoshitaka Tamura
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Kumamoto, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Kumamoto, Japan
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5
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Whittier WL. Complications of the percutaneous kidney biopsy. Adv Chronic Kidney Dis 2012; 19:179-87. [PMID: 22578678 DOI: 10.1053/j.ackd.2012.04.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 04/04/2012] [Accepted: 04/06/2012] [Indexed: 12/11/2022]
Abstract
Percutaneous kidney biopsy is an integral part of a nephrologist's practice. It has helped to define nephrology as a subspecialty. When indicated, it is a necessary procedure to help patients, as it allows for diagnostic, prognostic, and therapeutic information. Although very safe, this procedure can give rise to complications, mainly related to bleeding. Since its development in the 1950s, modifications have been made to the approach and the technique, which have improved the diagnostic yield while keeping it a safe procedure. Alterations to the standard approach may be necessary if risk factors for bleeding are present. In addition, obesity, pregnancy, and solitary kidney biopsy are all special circumstances that change the procedure itself or the risk of the procedure. Today, kidney biopsy is a vital procedure for the nephrologist: clinically relevant, safe, and effective.
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6
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Dausse F, Chevallier P, Motamedi JP, Amoretti N, Cua E, Bruneton JN. Lumbar false aneurysms following image-guided interventive procedures for spondylodiskitic abscesses. Skeletal Radiol 2006; 35:949-52. [PMID: 16528549 DOI: 10.1007/s00256-005-0064-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Revised: 08/08/2005] [Accepted: 10/25/2005] [Indexed: 02/02/2023]
Abstract
Pseudoaneurysms of the lumbar arteries are infrequent, and are most often found incidentally after trauma to the lumbar spine. More rarely, they are an iatrogenic complication from diagnostic or therapeutic procedures, particularly of the kidney. Their rupture can cause rapid clinical deterioration by retroperitoneal hemorrhage, and therefore their diagnosis and treatment must be rapid. We report two cases of lumbar artery false aneurysms arising as a complication during the treatment of infectious disciitis. The diagnoses were established via CT and immediately followed by expeditious treatment by selective arterial embolization.
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7
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Shigematsu Y, Kudoh K, Nakasone Y, Fujisaki T, Uemura S, Yamashita Y. Nontraumatic Rupture of Lumbar Artery Causing an Intravertebral Body Pseudoaneurysm: Treatment by Transcatheter Embolization. Cardiovasc Intervent Radiol 2006; 29:870-4. [PMID: 16718425 DOI: 10.1007/s00270-004-7187-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a case of nontraumatic rupture of the lumbar artery that led to a pseudoaneurysm in the vertebral body and massive retroperitoneal to retropleural hematoma. The pseudoaneurysm was successfully treated by endovascular embolization. To our knowledge, idiopathic rupture of the lumbar artery has been reported in a limited number of cases and pseudoaneurysm formation in the vertebral body has not been presented in the literature. The etiology of hemorrhage has been discussed based on CT, MRI, and three-dimensional rotational angiography.
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Affiliation(s)
- Yoshinori Shigematsu
- Department of Radiology, Internal Medicine, and Neurosurgery, Amakusa Medical Center, 854-1 Kameba, Hondo, Kumamato 863-0046, Japan.
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Janík V, Martínek V, Pádr R, Lisy J, Neuwirth J, Pafcugová J, Vanecek T, Stejskal J. Embolization of lumbar artery due to retroperitonal bleeding following renal biopsy. Nephrol Dial Transplant 2005; 20:820-2. [PMID: 15772268 DOI: 10.1093/ndt/gfh685] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Václav Janík
- Department of Diagnostic Imaging, University Hospital Motol, Prague, Czech Republic.
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9
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Zamora CA, Sugimoto K, Mori T, Taniguchi T, Tsurusaki M, Izaki K, Okada N, Nakamura M, Nakayama S, Ishii N, Sugimura K. Lumbar artery injury after self-stabbing in a hara-kiri suicide attempt: treatment by selective microcatheter embolization. ACTA ACUST UNITED AC 2005; 58:384-7. [PMID: 15706207 DOI: 10.1097/01.ta.0000078691.69719.c1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Carlos A Zamora
- Department of Radiology, Kobe University School of Medicine, Chuo-ku, Kobe-shi, Hyogo-ken, Japan.
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10
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Chan PN, Wong KT, Lee SF, Yu SCH. Lumbar artery bleeding as a complication of percutaneous nephrostomy in a patient with coagulopathy. Br J Radiol 2004; 77:878-80. [PMID: 15483003 DOI: 10.1259/bjr/15202270] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A case of severe lumbar artery bleeding as a complication of percutaneous nephrostomy (PCN) is presented. A 70-year-old man with coagulation disorder (factor VIII deficiency) underwent left PCN because of left hydronephrosis and abnormal renal function. The procedure was complicated by a major haemorrhage from the left first lumbar artery into the left posterior pararenal space. This case illustrates bleeding from the lumbar artery in a patient with coagulation disorder resulting in a fatal outcome. CT can provide the diagnosis, while angiography with embolisation is an effective means to control the bleeding. These examinations should be performed as soon as possible.
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Affiliation(s)
- P N Chan
- Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, NT, Hong Kong
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11
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Abstract
Percutaneous renal biopsy (PRB) is an integral part of the clinical practice of nephrology. It is essential in the diagnosis of glomerular, vascular, and tubulointerstitial diseases of the kidney, providing information that is invaluable in prognosis and patient management. The use of real-time ultrasound and automated biopsy needles has simplified and improved the success and safety of this procedure. In the recent past, we have seen a shift of the PRB from nephrologists to radiologists and this has raised appropriate concern that loss of this procedure may undermine the nephrologist's status as a subspecialist. We must continue to properly train young nephrologists in the proper technique and value of performing renal biopsy procedures or we stand to lose control of a procedure that was an integral part of the development of our subspecialty.
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Affiliation(s)
- Stephen M Korbet
- Section of Nephrology, Department of Medicine, Rush Presbyterian St. Lukes Medical Center Chicago, IL 60612, USA
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12
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Jain R, Kumar S, Phadke RV, Baijal SS, Gujral RB. Intra-arterial embolization of lumbar artery pseudoaneurysm following percutaneous nephrolithotomy. AUSTRALASIAN RADIOLOGY 2001; 45:383-6. [PMID: 11531772 DOI: 10.1046/j.1440-1673.2001.00880.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The management of a patient with haematuria following percutaneous nephrolithotomy is described. The patient underwent renal angiography to assess the cause of bleeding. A pseudoaneurysm arising from first left lumbar artery was incidentally discovered, which was then successfully embolized using an indigenously fabricated metallic coil and gel foam particles in the same sitting.
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Affiliation(s)
- R Jain
- Department of Radiodiagnosis, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Rae Bareily Road, Lucknow, Uttar Pradesh 226014, India
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14
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Lee KH, Park JH, Chung JW, Han JK, Shin SJ, Kang HS. Vascular complications in lumbar spinal surgery: percutaneous endovascular treatment. Cardiovasc Intervent Radiol 2000; 23:65-9. [PMID: 10656911 DOI: 10.1007/s002709910012] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Four patients underwent endovascular treatment of vascular injuries complicating lumbar spinal surgery. In two patients with massive retroperitoneal hemorrhage, the extravasating lumbar arteries were successfully embolized with microcoils. Two patients with large iliac arteriovenous fistula (AVF) were treated, one with embolization using a detachable balloon and coils, which failed, and the other with placement of a stent graft after embolization of distal runoff vessels, which occluded the fistula. We conclude that acute arterial laceration or delayed AVF complicating lumbar spinal surgery can be managed effectively with selective embolization or stent-graft placement, respectively.
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Affiliation(s)
- K H Lee
- Department of Radiology, College of Medicine, Seoul National University, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea
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Marty B, Sanchez LA, Wain RA, Ohki T, Marin ML, Bakal C, Veith FJ. Endovascular treatment of a ruptured lumbar artery aneurysm: case report and review of the literature. Ann Vasc Surg 1998; 12:379-83. [PMID: 9676937 DOI: 10.1007/s100169900172] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Lumbar artery aneurysms are uncommon lesions that usually present as pseudoaneurysms secondary to vessel injury. Despite their small size and retroperitoneal location, these lesions are potentially lethal once they rupture. This report describes a ruptured lumbar artery aneurysm which was successfully treated in a minimally invasive fashion. The diagnosis was suggested by computed tomography scan and confirmed with angiography. Successful treatment consisted of placing intravascular metallic coils into the lumbar artery. The literature contains only seven previous reports of ruptured lumbar artery aneurysms and these were managed either operatively or via an endovascular approach. Based upon the outcome of all reported cases, we believe that coil embolization of lumbar artery aneurysms following diagnostic angiography is an appropriate and effective mean of treating these lesions.
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Affiliation(s)
- B Marty
- Division of Vascular Surgery, Montefiore Medical Center, New York, New York 10467, USA
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