Normalization of renal function and blood pressure after dissolution with intra-arterial fibrinolytics of a massive renal artery embolism to a solitary functioning kidney

Percutaneous mechanical thrombectomy and pharmacologic thrombolysis for renal artery embolism: case report and review of endovascular treatment

Renal artery embolism (RAE) is an uncommon event that is associated with a high rate of renal loss. We present a case of RAE to a solitary kidney that was treated with combined percutaneous rheolytic thrombectomy, intra-arterial thrombolysis, and supplemental renal artery stent placement.

Nonsurgical treatment of acute iatrogenic renal artery injuries occurring after renal artery angioplasty and stenting

OBJECTIVE

The objective of this study was to determine the success of the nonsurgical treatment of acute iatrogenic renal artery injuries that occur after renal artery angioplasty and stenting at a tertiary referral center.

MATERIALS AND METHODS

During a 5-year period, 212 patients (308 renal arteries) underwent percutaneous transluminal angioplasty or stent dilatation of the renal artery. Through a retrospective review of medical and radiology records, we determined that 13 of these patients suffered iatrogenic renal artery injuries.

RESULTS

The renal arterial complication rates were 4.2% per artery treated and 6.1% per patient treated. All 13 patients were successfully treated nonsurgically. Five patients with acute rupture of the renal artery were treated immediately with balloon tamponade or with placement of an additional stent or stent-graft. Six patients suffered acute thrombotic occlusion; five were successfully treated with thrombolysis, and one was successfully treated without thrombolysis by the placement of an additional stent. Presumed distal guidewire perforation caused subcapsular hematoma in one patient and a perirenal and pararenal hematoma in another; both were successfully treated with conservative management. During the clinical follow-up period (mean period, 19 months), one patient required long-term hemodialysis. No other patients required additional treatment.

CONCLUSION

The nonsurgical treatment of acute iatrogenic renal artery injuries occurring after renal artery angioplasty and stenting can be successful and may obviate additional surgery.

Renal artery embolism: clinical features and therapeutic options

Renal artery embolism is an infrequent but important cause of renal loss. However, due to its rarity and nonspecific presentation diagnosis is often delayed and occasionally missed. Furthermore, proper therapeutic intervention is not well established and aggressive surgical management is often ill-advised. We review the literature and present 3 cases seen recently at our institution. Selective intra-arterial infusion of thrombolytic agents appears to be the most favorable treatment. The duration of occlusion does not necessarily correlate with the return of renal function, and the degree of collateral renal blood flow can be important.