1
|
Okada I, Inoue J, Kato H, Koido Y, Kiriu N, Hattori T, Morimoto K, Ichinose Y, Yokota H. Long-Term Outcomes of Endovascular Stenting for Blunt Renal Artery Injuries with Stenosis: A Report of Five Consecutive Cases. J NIPPON MED SCH 2019; 86:172-178. [PMID: 31292329 DOI: 10.1272/jnms.jnms.2019_86-306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Renal artery stenting is performed for renal artery injuries to preserve renal function and prevent renovascular hypertension. However, its indications are controversial and its long-term prognosis remains unknown. Here, we evaluate the characteristics and long-term outcomes of renal artery stenting for blunt renal artery injuries at our institution. METHODS We retrospectively reviewed patients with blunt renal artery injuries who had been treated with stenting over a 12-year period at our institution. Five patients (three men and two women) were included. RESULTS Trauma resulted from falls in three patients and motor vehicle accidents in two. All patients had experienced multiple injuries (median injury severity score, 24 [range, 16-48]; median revised trauma score, 5.9672 [4.0936-7.8408]; and median probability of survival, 0.689 [0.533-0.980]). All renal artery injuries involved stenosis because of traumatic arterial dissection or intimal tear; no cases of total occlusion were observed. No complications due to the intervention itself were observed. Although two patients developed reversible acute renal failure, none required long-term hemodialysis. One patient with renovascular hypertension was treated with antihypertensive agents for a month and subsequently became normotensive without further medication. All patients underwent postoperative computed tomography, which revealed no stent occlusion or renal atrophy. Renal scintigraphy for three patients demonstrated preserved differential renal function. All five patients survived. CONCLUSIONS Renal artery stenting for hemodynamically stable blunt renal artery injuries with stenosis is suggested to be safe and helps in avoiding long-term hemodialysis and renovascular hypertension.
Collapse
Affiliation(s)
- Ichiro Okada
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center
| | - Junichi Inoue
- Emergency and Critical Care Medical Center, Yamanashi Prefectural Central Hospital
| | - Hiroshi Kato
- Department of Emergency Medicine, Minamitama Hospital
| | - Yuichi Koido
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center
| | - Nobuaki Kiriu
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center
| | - Takayuki Hattori
- Department of Radiology, Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital
| | - Kohei Morimoto
- Department of Radiology, National Hospital Organization Disaster Medical Center
| | - Yoshiaki Ichinose
- Department of Radiology, National Hospital Organization Disaster Medical Center
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital
| |
Collapse
|
2
|
Zoulati M, Slaoui A, Bakkali T, Aghoutane N, Lyazidi Y, Chtata H, Janane A, Ameur A, Taberkant M. [Traumatic dissection of the left renal pedicle in a young adult]. JOURNAL DE MEDECINE VASCULAIRE 2018; 43:272-276. [PMID: 29981737 DOI: 10.1016/j.jdmv.2018.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 04/23/2018] [Indexed: 06/08/2023]
Abstract
Blunt trauma rarely causes renal pedicle dissection. Clinical signs are minimal and inconsistently reported. The diagnosis is based on computed tomographic angiography; arteriography is still useful when revascularization is considered. We report here a case of traumatic dissection with thrombosis of a juxta-aortic renal pedicle monitored in the intensive care unit. An endovascular procedure could not be proposed because of the juxta-aortic localization.
Collapse
Affiliation(s)
- M Zoulati
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay-Riad, Rabat, Maroc.
| | - A Slaoui
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay-Riad, Rabat, Maroc
| | - T Bakkali
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay-Riad, Rabat, Maroc
| | - N Aghoutane
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay-Riad, Rabat, Maroc
| | - Y Lyazidi
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay-Riad, Rabat, Maroc
| | - H Chtata
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay-Riad, Rabat, Maroc
| | - A Janane
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay-Riad, Rabat, Maroc
| | - A Ameur
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay-Riad, Rabat, Maroc
| | - M Taberkant
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay-Riad, Rabat, Maroc
| |
Collapse
|
3
|
Jahangiri Y, Ashwell Z, Farsad K. Percutaneous renal artery revascularization after prolonged ischemia secondary to blunt trauma: pooled cohort analysis. Diagn Interv Radiol 2018; 23:371-378. [PMID: 28870883 DOI: 10.5152/dir.2017.16415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to identify factors related to technical and clinical success of percutaneous revascularization for blunt renal arterial trauma. METHODS All cases of percutaneous revascularization for blunt renal arterial trauma were searched in the available literature. We included a case of iatrogenic renal artery occlusion at our institution treated by percutaneous stenting 20 hours after injury. A pooled cohort analysis of percutaneous revascularization for blunt renal artery injury was then performed to analyze factors related to technical and clinical success. Clinical failure was defined as development of new hypertension, serum creatinine rise, or significant asymmetry in split renal function. RESULTS A total of 53 cases have been reported, and 54 cases were analyzed including our case. Median follow-up was 6 months. Technical success was 88.9% and clinical success was 75%. Of 12 treatment failures (25%), 66.7% occurred during the first postprocedure month. Time from injury to revascularization was not a predictor of clinical success (OR=1.00, P = 0.681). Renal artery occlusion was significantly associated with clinical failure (OR=7.50, P = 0.017) and postintervention antiplatelet therapy was significantly associated with treatment success (OR=0.16, P = 0.043). At 37-month follow-up, the stented renal artery in our case remained patent and the patient was normotensive with preserved glomerular filtration rate. CONCLUSION Percutaneous revascularization for blunt renal arterial injury resulted in relatively high technical and clinical success. Time-to-revascularization was independent of successful outcomes. Clinical success was significantly associated with a patent renal artery at the time of intervention and with postprocedure antiplatelet therapy.
Collapse
Affiliation(s)
- Younes Jahangiri
- Department of Interventional Radiology, Charles T. Dotter Institute, Oregon Health and Science University, Portland, Oregon, USA.
| | | | | |
Collapse
|
4
|
Karaolanis G, Moris D, McCoy CC, Tsilimigras DI, Georgopoulos S, Bakoyiannis C. Contemporary Strategies in the Management of Civilian Abdominal Vascular Trauma. Front Surg 2018; 5:7. [PMID: 29516005 PMCID: PMC5826055 DOI: 10.3389/fsurg.2018.00007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 01/29/2018] [Indexed: 12/17/2022] Open
Abstract
The evaluation and management of patients with abdominal vascular trauma or injury requires immediate and effective decision-making in these unfavorable circumstances. The majority of these patients arrive at trauma centers in profound shock, secondary to massive blood loss, which is often unrelenting. Moreover, ischemia, compartment syndrome, thrombosis, and embolization may also be life threatening and require immediate intervention. To minimize the risk of these potentially lethal complications, early understanding of the disease process and emergent therapeutic intervention are necessary. In the literature, the management of acute traumatic vascular injuries is restricted to traditional open surgical techniques. However, in penetrating injuries surgeons often face a potentially contaminated field, which renders the placement of prosthetic grafts inappropriate. Currently, however, there are sparse data on the management of vascular trauma with endovascular techniques. The role of endovascular technique in penetrating abdominal vascular trauma, which is almost always associated with severe active bleeding, is limited. It is worth mentioning that hybrid operating rooms with angiographic radiology capabilities offer more opportunities for the management of this kind of injuries by either temporary control of the devastating bleeding using endovascular balloon tamponade or with embolization and stenting. On the other hand, blunt abdominal injuries are less dangerous and they could be treated at most times by endovascular means. Since surgeons continue to encounter abdominal vascular trauma, open and endovascular techniques will evolve constantly giving us encouraging messages for the near future.
Collapse
Affiliation(s)
- Georgios Karaolanis
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Moris
- Department of Surgery, Duke University Hospital, Durham, NC, United States
| | - C. Cameron McCoy
- Department of Surgery, Duke University Hospital, Durham, NC, United States
| | - Diamantis I. Tsilimigras
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Georgopoulos
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Chris Bakoyiannis
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
5
|
Lim KH, Ryeom HK, Park J. Endovascular treatment of renal arterial perforation after blunt trauma: Case report. Int J Surg Case Rep 2017; 42:208-211. [PMID: 29275235 PMCID: PMC5985259 DOI: 10.1016/j.ijscr.2017.11.069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Isolated renal arterial perforation is a rare consequence of blunt abdominal trauma. Meticulous surgical control of retroperitoneal active bleeding is difficult due to oozing of soft connective tissue, the deep position of operative field, and the presence of friable vascular tissue. Therefore, endovascular treatment is often preferred. PRESENTATION OF CASE An 83-year-old man was transferred to our trauma center due to retroperitoneal active bleeding after a car accident, in which his right upper abdomen struck the steering wheel. Contrast-enhanced abdominal computed tomography (CT) showed a retroperitoneal hematoma behind the inferior vena cava and contrast medium extravasation on the medial side of the right kidney. Selective right renal arteriography confirmed a perforation in the proximal right main renal artery, approximately 3 cm from the ostium. We successfully placed a covered stent across the perforation site. DISCUSSION Endovascular management may reduce the likelihood of extensive abdominal surgery, surrounding organ damage, risk of bleeding, and postoperative morbidity. We regarded embolization as inappropriate for kidney salvage in our patient, and therefore used a self-expanding covered stent to treat the perforation. CONCLUSION Endovascular management of a traumatic renal arterial injury is the best approach to preserve renal function in hemodynamically stable patients who cannot tolerate laparotomy, due to risks associated with general anesthesia, and who can tolerate anticoagulation therapy.
Collapse
Affiliation(s)
- Kyoung Hoon Lim
- Department of Surgery, Trauma Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hun Kyu Ryeom
- Department of Radiology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jinyoung Park
- Department of Surgery, Trauma Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea.
| |
Collapse
|
6
|
Beyer C, Zakaluzny S, Humphries M, Shatz D. Multidisciplinary Management of Blunt Renal Artery Injury with Endovascular Therapy in the Setting of Polytrauma: A Case Report and Review of the Literature. Ann Vasc Surg 2017; 38:318.e11-318.e16. [DOI: 10.1016/j.avsg.2016.05.130] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 05/04/2016] [Accepted: 05/25/2016] [Indexed: 11/16/2022]
|
7
|
Abstract
Renal trauma is predominantly secondary to blunt trauma and is managed nonoperatively. Endovascular interventions are reserved for patients with a significant vascular injury recognized early. Renal injuries are uncommon among intra-abdominal injuries and account for a minority of injuries treated by the vascular specialist.
Collapse
Affiliation(s)
- Emelia N Bittenbinder
- Pennsylvania State University College of Medicine, Division of Vascular Surgery, Penn State Milton S Hershey Medical Center, Heart and Vascular Institute, 500 University Drive Hershey, PA 17033
| | - Amy B Reed
- Pennsylvania State University College of Medicine, Division of Vascular Surgery, Penn State Milton S Hershey Medical Center, Heart and Vascular Institute, 500 University Drive Hershey, PA 17033.
| |
Collapse
|
8
|
Afshinnia F, Sundaram B, Rao P, Stanley J, Bitzer M. Evaluation of characteristics, associations and clinical course of isolated spontaneous renal artery dissection. Nephrol Dial Transplant 2013; 28:2089-98. [PMID: 23563282 DOI: 10.1093/ndt/gft073] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Spontaneous renal artery dissection (SRAD) is a rare entity of unknown etiology. We aimed to study the clinical course and outcomes and compare the characteristics of patients with SRAD with those of the general population. METHODS All cases of isolated renal artery dissection diagnosed at the University of Michigan Hospitals between January 2000 and July 2012 were identified by the ICD-9 code. Cases were matched by age, gender and race with individuals from the 2009-2010 National Health and Nutrition Examination Survey (NHANES). Characteristics and awareness of comorbid conditions were compared. Information about the clinical course after diagnosis was retrieved from the case group to ascertain their outcomes. RESULTS Overall, 17 patients with SRAD with a mean age of 38.6 years (SD = 8.3) were identified. Eleven patients were male and 14 were white. The most common presenting symptom was excruciating sudden-onset flank pain ipsilateral to the site of dissection. Fibromuscular dysplasia, Ehlers-Danlos and polyarteritis nodosa were present in 4, 4 and 1 patients, respectively. After adjusting in a multivariable model, the case group was more likely to report history of hypertension, cancer and connective tissue disorders (P < 0.001), and less likely to have obesity (BMI ≥30 kg/m(2)) compared with the general population. Supportive medical treatment, endovascular intervention and surgery were required in 8, 5 and 4 cases, respectively. After discharge from the hospital, hypertension was adequately controlled in all the patients but one. CONCLUSION SRAD may be part of a syndrome having multi-organ involvement. With appropriate medical or surgical management, long-term clinical outcome appears favorable.
Collapse
Affiliation(s)
- Farsad Afshinnia
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | | |
Collapse
|
9
|
Shiber J, Fontane E. Bilateral traumatic renal artery dissection. TRAUMA-ENGLAND 2012. [DOI: 10.1177/1460408612440929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present a case of bilateral renal artery dissection, with the related computed tomographic images, caused by blunt torso trauma. Discussion includes the etiologies of this type of injury, the diagnostic modalities, and treatment options.
Collapse
|
10
|
Morey AF. Re: Radiological Treatment of Renal Artery Occlusion After Blunt Abdominal Trauma in a Pediatric Patient: Is it Never Too Late? J Urol 2012; 187:552-3. [DOI: 10.1016/j.juro.2011.10.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
11
|
Lopera JE, Suri R, Kroma G, Gadani S, Dolmatch B. Traumatic Occlusion and Dissection of the Main Renal Artery: Endovascular Treatment. J Vasc Interv Radiol 2011; 22:1570-4. [DOI: 10.1016/j.jvir.2011.08.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 07/24/2011] [Accepted: 08/01/2011] [Indexed: 11/26/2022] Open
|
12
|
Radiological Treatment of Renal Artery Occlusion After Blunt Abdominal Trauma in a Pediatric Patient: Is It Never Too Late? Urology 2011; 77:1220-2. [DOI: 10.1016/j.urology.2010.06.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2010] [Revised: 05/23/2010] [Accepted: 06/19/2010] [Indexed: 11/18/2022]
|
13
|
Chow SJD, Thompson KJ, Hartman JF, Wright ML. A 10-year review of blunt renal artery injuries at an urban level I trauma centre. Injury 2009; 40:844-50. [PMID: 19486971 DOI: 10.1016/j.injury.2008.11.022] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Revised: 08/30/2008] [Accepted: 11/06/2008] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Little consensus exists over the management of high-grade renal injuries, with continued debate over observation versus invasive surgery. Blunt renal artery injury (BRAI) is a high-grade injury that may result in renal dysfunction, hypertension, or failure. MATERIALS AND METHODS Management of BRAI at a level I trauma centre during a decade was retrospectively reviewed to determine incidence, assess management strategy, and evaluate hospital outcomes. Data collected included demographics, injury details, standardised scoring, renal injury grade, haemodynamic stability, diagnostic modalities, medical interventions, mortality, and hospitalisation length. RESULTS Thirty-eight BRAI patients (21 Grade IV and 17 Grade V injuries) were admitted, representing 0.16% of trauma admissions, and consisting primarily of young males. Ultrasonography and CT was performed in 92.1% and 76.3% of patients, respectively. Primary management included exploratory laparotomy in 42.9%, angiography and embolisation in 34.3%, and observation in 22.9%. Six nephrectomies and one revascularisation were performed. The incidence of BRAI and use of angiography are higher than those reported in previous studies. CONCLUSION Over the past decade, increased use of CT as a diagnostic tool for confirming renal injury in haemodynamically stable patients at our institution may have contributed to the increase in BRAI detection. Higher utilisation of angiography has enabled a more conservative approach. In this series, angiography had a success rate of 94.4%. Angiography and embolisation or observation with careful monitoring are viable management options in haemodynamically stable patients with isolated BRAI.
Collapse
Affiliation(s)
- Stuart J D Chow
- Grant Medical Center, Columbus, Ohio, 111 South Grant, Columbus, OH 43215, USA.
| | | | | | | |
Collapse
|
14
|
Civy AM, Seguin P, Frouget T, Tanguy M, Heautot JF, Mallédant Y. [Bilateral traumatic dissection of the renal arteries]. ACTA ACUST UNITED AC 2008; 27:727-30. [PMID: 18752919 DOI: 10.1016/j.annfar.2008.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 06/16/2008] [Indexed: 11/19/2022]
Abstract
The bilateral dissection of the renal arteries is uncommon after blunt trauma. The clinical symptoms are scarce and inconstant. The diagnosis is based on contrast-enhanced computed tomography with intravenous contrast and angiographic examination is required only if an endovascular revascularization is envisaged. We reported here, an exceptional case of bilateral traumatic dissection of the renal arteries associated with acute renal failure. The delayed revascularization does not allow the recuperation of a renal function.
Collapse
Affiliation(s)
- A-M Civy
- Service réanimation chirurgicale, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | | | | | | | | | | |
Collapse
|
15
|
Affiliation(s)
- Bryan B. Voelzke
- From the Department of Urology, San Francisco General Hospital, San Francisco, California
| | - Jack W. Mcaninch
- From the Department of Urology, San Francisco General Hospital, San Francisco, California
| |
Collapse
|