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Renaud S, Leray-Moraguès H, Chenine L, Canaud L, Vernhet-Kovacsik H, Canaud B. Spontaneous renal artery dissection with renal infarction. Clin Kidney J 2015; 5:261-4. [PMID: 26069781 PMCID: PMC4400519 DOI: 10.1093/ckj/sfs047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 03/30/2012] [Indexed: 12/03/2022] Open
Abstract
Spontaneous renal artery dissection (SRAD) is a rare entity, which often presents diagnostic difficulties because of its non-specific clinical presentation. We report six cases complicated with renal infarction, occurring in middle-aged male patients without risk factors, illustrating the difficulty and delay for diagnosing SRAD. Ultrasound and Doppler imaging were not sensitive enough to confirm the diagnosis, and contrast-enhanced abdominal computed tomography was used to correct the diagnosis and allow the clinicians to propose appropriate treatment. We conclude that considering the urgency in diagnosing and treating SRAD, contrast enhanced abdominal tomography and/or abdominal magnetic resonance imaging should be proposed as soon as a suspicion of SRAD is evoked by the clinical presentation.
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Affiliation(s)
- Sophie Renaud
- Physiology Department, George Pompidou European Hospital, APHP, Paris, France
| | - Hélène Leray-Moraguès
- Nephrology, Dialysis and Intensive Care Unit, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Leila Chenine
- Nephrology, Dialysis and Intensive Care Unit, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Ludovic Canaud
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - Hélène Vernhet-Kovacsik
- Vascular and Radiology Department, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - Bernard Canaud
- Nephrology, Dialysis and Intensive Care Unit, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
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Jain A, Tracci MC, Coleman DM, Cherry KJ, Upchurch GR. Renal malperfusion: spontaneous renal artery dissection and with aortic dissection. Semin Vasc Surg 2013; 26:178-88. [DOI: 10.1053/j.semvascsurg.2014.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Orhan O, Kultigin T, Osman K, Yalcin S, Melih A, Niyazi G. An exceedingly rare cause of secondary hypertension: bilateral renal artery dissection possibly secondary to extracorporeal shock-wave lithotripsy (ESWL). Intern Med 2011; 50:2633-6. [PMID: 22041371 DOI: 10.2169/internalmedicine.50.5351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Extracorporeal shock-wave lithotripsy (ESWL) is an effective and relatively non-invasive treatment modality for ureteral or renal calculi. Although it has been accepted as a safe procedure, minor and major complications have been reported after ESWL. Spontaneous renal artery dissection (SRAD) is a rare and usually misdiagnosed condition because of non-specific presentation of the patients. Depending on the severity of the extent of the dissection non-operative or surgical treatment modalities could be performed. We represent a patient with complaints of bilateral flank pain, hematuria and hypertensive urgency who was diagnosed as having bilateral SRAD possibly secondary to ESWL and chronic hypertension.
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Affiliation(s)
- Ozbek Orhan
- Department of Radiology, School of Medicine, Selcuk University, Turkey
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Iqbal FM, Goparaju M, Yemme S, Lewis BE. Renal Artery Dissection following Marathon Running. Angiology 2008; 60:122-6. [DOI: 10.1177/0003319707310278] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 38-year-old, previously healthy man presented with flank pain after competing in a marathon. Initial laboratory tests and urinalysis were essentially normal. Both contrast enhanced—computed tomography and magnetic resonance angiography showed an infarcted region of the left lower kidney without renal artery dissection. Thromboembolism was suspected, but further testing was negative. The diagnosis of renal artery dissection was established by angiogram, showing dissection of the segmental branch. The patient remained normotensive, maintained normal renal function, and had resolution of pain symptoms prior to discharge. On the basis of our experience and review of the literature, renal artery dissection occurs in otherwise healthy men and often goes undiagnosed. The management strategy tends to be conservative unless the patient develops progressive decline in renal function or worsening hypertension, with an excellent prognosis. This case also shows the importance of discussing the pros and cons of extreme physical exertion with all patients.
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Affiliation(s)
- Fahad M. Iqbal
- Department of Internal Medicine, St Joseph Hospital, Chicago
| | | | - Soumya Yemme
- Department of Internal Medicine, St Joseph Hospital, Chicago
| | - Bruce E. Lewis
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois
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Muraoka N, Sakai T, Kimura H, Uematsu H, Tanase K, Yokoyama O, Itoh H. Rare Causes of Hematuria Associated with Various Vascular Diseases Involving the Upper Urinary Tract. Radiographics 2008; 28:855-67. [DOI: 10.1148/rg.283075106] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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6
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Ullrick SR, Wojtowycz M. Utility of percutaneous treatment in spontaneous renal artery dissection: case report and review of the literature. Semin Intervent Radiol 2007; 24:63-7. [PMID: 21326739 DOI: 10.1055/s-2007-971188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Spontaneous renal artery dissection (SRAD) is a relatively rare entity that has been described in several case reports and small series in the medical literature. The condition is best diagnosed with angiography, with renal ischemia or infarction a common complication. Conservative medical management, surgical intervention, and percutaneous intervention are all discussed in the current literature. However, there is no consensus on which treatment option provides the best clinical outcome. Percutaneous stent placement has only recently been considered as an option for treatment of SRAD. This case report reviews the course of an otherwise healthy patient with a solitary right kidney who had SRAD complicated by renal infarction and was treated by percutaneous renal artery stent placement. Subsequently, we discuss and review the literature on SRAD treatment.
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Affiliation(s)
- Steven R Ullrick
- Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
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Stawicki SP, Rosenfeld JC, Weger N, Fields EL, Balshi JD. Spontaneous renal artery dissection: three cases and clinical algorithms. J Hum Hypertens 2006; 20:710-8. [PMID: 16710291 DOI: 10.1038/sj.jhh.1002045] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Spontaneous renal artery dissection (SRAD) is rare. Clinical manifestations vary from minimal symptoms to life-threatening hypertension. We analysed three cases from our institution and conducted a literature review in order to design diagnostic and treatment algorithms for SRAD.
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Ando T, Ohno H, Hirata Y, Emoto A, Ogata S, Mimata H. Spontaneous recovery from renal infarction resulting from renal artery dissection. Int J Urol 2005; 12:405-8. [PMID: 15948731 DOI: 10.1111/j.1442-2042.2005.01062.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 31-year-old, previously normotensive healthy man developed right flank pain and was admitted to a medical service. Right renal infarction was suspected by enhanced abdominal computed tomography (CT) and arteriography. Fourteen days after the onset, he was transferred to the Oita University Hospital, Oita, Japan. Renal angiography revealed an isolated renal artery dissection causing renal atrophy due to main stem narrowing of the right renal artery. Renogram and renal scintigram with (99m)Tc-diethylene triamine pentaacetic acid revealed a remarkable decline in the glomerular filtration rate and almost no uptake in the right kidney. Four months later, in spite of our belief that functional recovery could not be expected, intravenous pyelography and enhanced abdominal CT scans revealed a functioning right kidney that had spontaneously recovered from the renal artery dissection through conservative management.
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Affiliation(s)
- Tadasuke Ando
- Department of Oncological Science, Urology, Faculty of Medicine, Oita University, Oita, Japan.
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Lupattelli T, Basile A, Iozzelli A, Quarenghi M, Nano G, Casana R, Malacrida G. Thrombolytic therapy followed by stenting for renal artery dissection secondary to blunt trauma. Emerg Radiol 2005; 11:164-6. [PMID: 16028321 DOI: 10.1007/s10140-004-0390-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 18-year-old man presented at our clinic with pain in the right flank following a motorbike accident. The diagnosis of renal artery dissection followed by thrombosis was made by computed tomography and confirmed by angiography. Successful revascularization was performed by means of repeated transcatheter injection of small doses of thrombolytic agents within the vessel, followed by deployment of a self-expandable stent. There were no complications, and the patient recovered well. Six months after stent placement, a selective renal angiogram showed excellent flow through the stented portion of the artery and normal parenchyma enhancement in the right kidney.
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Lee SH, Lee HC, Oh SJ, Park MC, Park KJ, Moon YS, Min JW, Hwang EJ, Baek JE, Jo ES, Jang GJ. Percutaneous intervention of spontaneous renal artery dissection complicated with renal infarction: A case report and literature review. Catheter Cardiovasc Interv 2003; 60:335-8. [PMID: 14571483 DOI: 10.1002/ccd.10657] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Spontaneous renal artery dissection (SRAD) is a rare condition that occurs before renal infarction. Using percutaneous intervention to treat SRAD remains controversial because it is not clear whether it is feasible or effective. We describe a 48-year-old male patient with SRAD complicated with renal infarction who was successfully treated with percutnaeous angioplasty and renal artery stenting.
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Affiliation(s)
- Sang Hak Lee
- Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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van Rooden CJ, van Baalen JM, van Bockel JH. Spontaneous dissection of renal artery: long-term results of extracorporeal reconstruction and autotransplantation1. J Vasc Surg 2003; 38:116-22. [PMID: 12844100 DOI: 10.1016/s0741-5214(02)75453-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE We undertook this study to assess the outcome of spontaneous dissection of the renal artery and its branches surgically treated with extracorporeal reconstruction and autotransplantation. SUBJECTS Between 1975 and 1996, 15 consecutive patients (19 kidneys) with spontaneous renal artery dissection underwent renal artery reconstruction. Fourteen patients had accelerated hypertension. Five patients had impaired renal function. In 14 patients the dissection was associated with fibrodysplasia, and in 1 patient it was related to arteriosclerosis. INTERVENTION In 17 kidneys extracorporeal reconstruction and autotransplantation was used. The renal artery of 1 kidney was reconstructed in situ. One primary nephrectomy was performed. RESULTS There were no operative deaths or major morbidity. All but 1 reconstruction was successful (94.4%). Results at follow-up (range, 1-8 years) were favorable in 14 patients; 79% had satisfactory blood pressure control, and all patients had normal renal function, including those with impaired renal function preoperatively. CONCLUSIONS Extracorporeal reconstruction and autotransplantation can be effectively used in patients with spontaneous renal artery dissection located in or extending into the distal branches. Early recognition and appreciation of the clinical presentation of spontaneous renal artery dissection are important.
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Mudrick D, Arepally A, Geschwind JF, Ronsivalle JA, Lund GB, Scheel P. Spontaneous renal artery dissection: treatment with coil embolization. J Vasc Interv Radiol 2003; 14:497-500. [PMID: 12682209 DOI: 10.1097/01.rvi.0000064845.87207.70] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A 47-year-old man presented with nonspecific left flank pain and severe hypertension as a result of a spontaneous dissection of an accessory renal artery. Because of the progressive increase in the size of the dissection flap and uncontrollable hypertension, treatment with segmental embolization of the true and false lumen of the accessory renal artery was performed with successful clinical outcome. This case report will address the salient clinical features of spontaneous renal artery dissections and treatment options.
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Affiliation(s)
- Daniel Mudrick
- Russell H. Morgan Department of Radiology and Radiological Science Division of Cardiovascular and Interventional Radiology, Johns Hopkins Medical Institutes, Baltimore, Maryland 21287, USA
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Müller BT, Reiher L, Pfeiffer T, Müller W, Hort W, Voiculescu A, Grabensee B, Fürst G, Sandmann W. Surgical treatment of renal artery dissection in 25 patients: indications and results. J Vasc Surg 2003; 37:761-8. [PMID: 12663975 DOI: 10.1067/mva.2003.171] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Results of surgical revascularization in 25 patients with renal artery dissection (RAD) over 14 years, with mean follow-up of 55.3 months (range, 10-111 months), were analyzed. Indications for surgery were renovascular hypertension and preservation or improvement of kidney function. PATIENTS AND METHODS Two patients (both 20 years of age) underwent emergency surgery after severe trauma; 23 patients (mean age, 41 years) underwent elective surgery in a chronic stage of disease. Preoperative, postoperative, and follow-up examinations included duplex ultrasound scanning, determination of serum creatinine and urea concentrations, and evaluation of blood pressure control. All long-term patients underwent digital subtraction angiography preoperatively and postoperatively. All histologic specimens of resected renal arteries were re-evaluated by two independent pathologists. RESULTS Histologic re-evaluation confirmed the traumatic origin in 2 patients who underwent emergency surgery and 1 who underwent elective surgery. Renal artery dissection developed spontaneously, with no histologic signs of trauma or fibromuscular dysplasia, in 22 patients. In 17 revascularized kidneys (61%) a kidney infarction had already developed preoperatively, and the kidneys were diminished in size or function. Results of revascularization and improvement of hypertension depended on preoperative extent of renal infarction. Hypertension resolved or improved in 86% of patients without preoperative kidney damage, but in only 38% with preoperatively damaged kidneys. Kidney function was preserved in 23 of 28 revascularized kidneys (82%). During follow-up, late renal artery occlusion developed in 3 kidneys. CONCLUSIONS Renal artery dissection can be effectively treated with surgical revascularization. Primary nephrectomy should be considered only in patients with a large ischemic kidney infarction, with significant deterioration of kidney function, to effectively cure or improve severe renovascular hypertension.
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Affiliation(s)
- Barbara Theresia Müller
- Department of Vascular Surgery and Kidney Transplantation, Heinrich-Heine-University Düsseldorf, Germany.
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Ramamoorthy SL, Vasquez JC, Taft PM, McGinn RF, Hye RJ. Nonoperative management of acute spontaneous renal artery dissection. Ann Vasc Surg 2002; 16:157-62. [PMID: 11972245 DOI: 10.1007/s10016-001-0154-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Isolated spontaneous renal artery dissection is a rare condition that can result in renal parenchymal loss and severe hypertension. Although several risk factors have been identified in association with renal artery dissection, the natural history is not well defined. The rarity and nonspecific presentation of the disease often lead to diagnostic delay. That, coupled with the anatomic limitations imposed by dissection into small branch arteries, frequently precludes successful revascularization. Over a 12-month period, four cases of spontaneous renal artery dissection (SRAD) were treated at a single institution. The patients (ages 44-58 years) presented with acute onset of abdominal/flank pain, fever, and hematuria. Diagnostic work-up included an abdominal CT scan revealing segmental renal infarction. Angiographic evaluation was diagnostic for renal artery dissection in all cases. In one case there was evidence of fibromuscular dysplasia (FMD), and in a second there was acute dissection superimposed upon atherosclerotic disease. Diagnosis was made within 12-72 hr of the onset of symptoms. All patients were managed expectantly with anticoagulation. Two patients were known to have a history of hypertension prior to admission. All four patients have required antihypertensive treatment following dissection, but the condition has been easily controlled. Renal function has remained stable in all cases. None of the four cases required exploration. Two of the four patients underwent repeat angiographic evaluation for recurrent symptoms of pain. In the case of the patient with FMD, a new dissection was seen in the contralateral renal artery, and in the second, repeat angiogram revealed proximal remodeling of the dissected artery. Management strategies for SRAD include surgical revascularization, endovascular intervention, and observation with or without anticoagulation. The available literature does not demonstrate a clear benefit of treatment with any of these modalities. In the short term, the combination of anticoagulation and expectant management appears to produce satisfactory outcomes for this difficult problem.
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Affiliation(s)
- Sonia L Ramamoorthy
- Department of Surgery, University of California, San Diego Medical Center, San Diego, CA, USA
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Abstract
PURPOSE The aim of this study was to assess the results of surgical treatment in a series of patients who underwent operation for isolated spontaneous dissection of the renal artery. The feasibility of renal artery reconstruction is emphasized. METHODS During a 21-year period (1978-1998), 22 patients (17 men, 5 women) with spontaneous dissection of the renal artery underwent operation. Their mean age was 41 +/- 8.4 years. All patients were admitted with uncontrollable arterial hypertension and underwent the usual investigations performed in subjects with hypertension. Because of bilateral lesions (3 patients), surgical treatment consisted of eight nephrectomies (6 total, 2 partial) and 17 arterial repairs (in 16 patients) carried out by conventional in situ surgery (6 cases) or by extracorporeal repair (11 cases). RESULTS There were no postoperative deaths or morbidity in this series. Arterial hypertension was cured in 9 patients (41%), improved in 11 (50%), and unchanged in 2 (9%). Anatomic results of repairs were excellent in 13 patients (81%) and incomplete in three (19%). During long-term follow-up, one late thrombosis of a repaired polar artery and one spontaneous dissection of the contralateral renal artery occurred. In eight patients, late angiographies showed that the results of reconstructions remained stable with time. CONCLUSIONS Surgical treatment of isolated spontaneous dissection of the renal artery is indicated in patients who have severe uncontrollable hypertension despite extensive medical treatment. Arterial repair is the ideal treatment. It is often possible even when complex lesions are present; in such cases ex vivo surgery affords great safety and ease of repair. Results concerning control of hypertension are satisfactory.
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Affiliation(s)
- M Lacombe
- Consultation de Chirurgie, Hôpital Beaujon, Clichy, France
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Knudson MM, Harrison PB, Hoyt DB, Shatz DV, Zietlow SP, Bergstein JM, Mario LA, McAninch JW. Outcome after major renovascular injuries: a Western trauma association multicenter report. THE JOURNAL OF TRAUMA 2000; 49:1116-22. [PMID: 11130498 DOI: 10.1097/00005373-200012000-00023] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Major renal vascular injuries are uncommon and are frequently associated with a poor outcome. In addition to renal dysfunction, posttraumatic renovascular hypertension may result, although the true incidence of this complication is unknown. The objective of this study was to describe the factors contributing to outcome after major renovascular trauma. We hypothesized that the highest percentage of renal salvage would be achieved by minimizing the time from injury to repair. METHODS This was a retrospective chart review over a 16-year period conducted at six university trauma centers of patients with American Association for the Surgery of Trauma grade IV/V renal injuries surviving longer than 24 hours. Postinjury renal function with poor outcome was defined as renal failure requiring dialysis, serum creatinine greater than or equal to 2 mg/dL, renal scan showing less than 25% function of the injured kidney, postinjury hypertension requiring treatment, or delayed nephrectomy. Data collected for analysis included demographics, mechanism of injury, presence of shock, presence of hematuria, associated injuries, type of renal injury (major artery, renal vein, segmental artery), type of repair (primary vascular repair, revascularization, observation, nephrectomy), time from injury to definitive renal surgery, and type of surgeon performing the operation (urologist, vascular surgeon, trauma surgeon). RESULTS Eighty-nine patients met inclusion criteria; 49% were injured from blunt mechanisms. Patients with blunt injuries were 2.29 times more likely to have a poor outcome compared with those with penetrating injuries. Similarly, the odds ratio of having a poor outcome with a grade V injury (n = 32) versus grade IV (n = 57) was 2.2 (p = 0.085). Arterial repairs had significantly worse outcomes than vein repairs (p = 0.005). Neither the time to definitive surgery nor the operating surgeon's specialty significantly affected outcome. Ten percent (nine patients) developed hypertension or renal failure postoperatively: three had immediate nephrectomies, four had arterial repairs with one intraoperative failure requiring nephrectomy, and two were observed. Of the 20 good outcomes for grade V injuries, 15 had immediate nephrectomy, 1 had a renal artery repair, 1 had a bypass graft, 1 underwent a partial nephrectomy, and 2 were observed. CONCLUSION Factors associated with a poor outcome following renovascular injuries include blunt trauma, the presence of a grade V injury, and an attempted arterial repair. Patients with blunt major vascular injuries (grade V) are likely to have associated major parenchymal disruption, which contributes to the poor function of the revascularized kidney. These patients may be best served by immediate nephrectomy, provided that there is a functioning contralateral kidney.
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Affiliation(s)
- M M Knudson
- San Francisco General Hospital of the University of California, 94110, USA
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Villas PA, Cohen G, Putnam SG, Goldberg A, Ball D. Wallstent placement in a renal artery after blunt abdominal trauma. THE JOURNAL OF TRAUMA 1999; 46:1137-9. [PMID: 10372642 DOI: 10.1097/00005373-199906000-00035] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- P A Villas
- Department of Diagnostic Imaging, Temple University Hospital, Philadelphia, Pennsylvania 19140, USA
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Whigham CJ, Bodenhamer JR, Miller JK. Use of the Palmaz stent in primary treatment of renal artery intimal injury secondary to blunt trauma. J Vasc Interv Radiol 1995; 6:175-8. [PMID: 7787349 DOI: 10.1016/s1051-0443(95)71088-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- C J Whigham
- Department of Radiology, Baylor College of Medicine, Houston, TX 77030-3498
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