Successful Wallstent implantation for extensive iatrogenic renal artery dissection in a patient with fibromuscular dysplasia

Spontaneous renal artery dissection: three cases and clinical algorithms

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.

Percutaneous intervention of spontaneous renal artery dissection complicated with renal infarction: A case report and literature review

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.

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.