Blunt renal artery injuries are rare, and no single trauma center has accumulated sufficient experience to draw meaningful conclusions or recommendations about optimal therapeutic strategies.
The increased use of CT scans to evaluate blunt abdominal trauma identifies more acute renal artery injuries that may have gone undetected.
Patients with renal injury have limited options such as open surgical repair or anticoagulation. The use of endovascular stents to treat trauma is a good option treatment.  But not every case is successful.
The purpose of this case report is to describe the importance of accurate diagnosis and successful repair in emergency traumatic conditions by means of interventional radiology in cases of intimal damage to the renal arteries.
We will present a 38-year-old man who shows on the emergency room because of an accident with abdominal and thoracic trauma. The patient complained of pain in the right side of the abdomen…
Through Angiography, an intimal dissection localized in the upper pole of the right kidney was confirmed. We inserted an expandable balloon stent using a transfemoral approach to successfully repair the dissection.
Conclusion: Blunt renal artery injury is rare. Nonoperative management should be considered an acceptable therapeutic option. Management of blunt renal injuries includes timely evaluation to maximize the preservation of renal function. Recent management trends support the consideration of endoluminal intervention for traumatic renal artery dissections.
Sangthong B, Demetriades D, Martin M, Salim A, Brown C, Inaba K, Rhee P, Chan L. Management and hospital outcomes of blunt renal artery injuries: analysis of 517 patients from the National Trauma Data Bank. J Am Coll Surg. 2006 Nov;203(5):612-7. doi: 10.1016/j.jamcollsurg.2006.07.004. Epub 2006 Sep 27. PMID: 17084321.
Bruce LM, Croce MA, Santaniello JM, et al. Blunt renal artery injury: incidence, diagnosis, and management. The American Surgeon. 2001 Jun;67(6):550-4; discussion 555-6. PMID: 11409803.
Knudson MM, Harrison PB, Hoyt DB, et al. Outcome after major renovascular injuries: a Western trauma association multicenter report. J Trauma. 2000; 49:1116–1122.
Carroll PR, McAninch JW, Klosterman P, et al. Renovascular trauma: risk assessment, surgical management, and outcome. J Trauma. 1990; 30: 547–552. discussion 553–554.
Baghdanian AH, Baghdanian AA, Armetta A, Babayan RK, LeBedis CA, Soto JA, Anderson SW. Utility of MDCT findings in predicting patient management outcomes in renal trauma. Emerg Radiol. 2017 Jun;24(3):263-272. [PubMed] [Reference list]
Ząbkowski T, Skiba R, Saracyn M, Zieliński H. Analysis of Renal Trauma in Adult Patients: A 6-Year Own Experiences of Trauma Center. Urol J. 2015 Sep 04;12(4):2276-9. [PubMed] [Reference list]
McPhee M, Arumainayagam N, Clark M, Burfitt N, DasGupta R. Renal injury management in an urban trauma centre and implications for urological training. Ann R Coll Surg Engl. 2015 Apr;97(3):194-7. [PMC free article] [PubMed] [Reference list]
Von Recklinghausen F. Haemorrhagische Niereninfarkte. Arch Path Anat Physiol.1861;20:205–7. [in German] [Google Scholar] [Ref list]
Rohl L. Vascular surgery in urology. Proc R Soc Med 1971; 64: 589-94.
Clarke RA. Traumatic renal artery occlusion. J trauma 1979; 19: 270-4.
Haas C, Dinchman K, Nasrallah F, Spirnak JP. Traumatic renal artery occlusion: a 15-year review. J trauma 1998; 45: 557-61.
Spirnak JP, Resnick MI. Revascularization of traumatic thrombosis of the renal artery. Surg Gynecol Obstet 1987; 164: 22-6.
Villas PA, Cohen G, Putnam SG. Wallstent placement in a renal artery after blunt abdominal trauma. J Trauma 1999; 46: 1137-9
Goodman DN, Saibil EA, Kodama RT. Traumatic intimal tear of the renal artery treated by insertion of a Palmaz stent. Cardiovasc Intervent Radiol. 1998; 21: 69–72.
Breyer BN, Master VA, Marder SR, McAninch JW. Endovascular management of trauma related renal artery thrombosis. J Trauma 2008; 64 (4): 1123-5.
Abu-Gazala M, Shussman N, Abu-Gazala S, Elazary R, Bala M, Rozenberg S, Klimov A, Rivkind AI, Arbell D, Almogy G, Bloom AI. Endovascular management of blunt renal artery trauma. Isr Med Assoc J. 2013 May;15(5):210-5. PMID: 23841239.
Cass AS. Renovascular injury from external trauma. Urol Clin North Am 1989;16: 213-19.
Montgomery RC, Richardson JD, Harty JI. Posttraumatic renovascular hypertension after occult renal injury. J Trauma 1998; 45: 106-10.
Long JA, Manel A, Penillon S, et al. Traumatic dissection of the renal pedicle. Modalities of management in adults and children. Prog Urol. 2004; 14: 302–309.
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 Intervent
Radiol 1995; 6: 175-8.
Bala M, Bloom AI, Appelbaum L, Levensart P, Rivkind AI. Early diagnosis of
blunt renal artery injury and endovascular treatment. IMAJ Isr Med Assoc J 2009;
Siddharth Pandey, Ajay Aggarwal, Manoj Kumar, Satyanarayan Sankhwar, Spontaneous
renal infarct heralding bowel ischaemia in an adult male: lessons to learn from a rare clinical association, BMJ Case Reports, 10.1136/bcr-2017-223745, (bcr-2017-223745), (2018).
Zahoor Ahmed, Syed Nabir, Mohamed Nadeem Ahmed, Shatha Al Hilli, Vajjala Ravikumar, Umais Zaid Momin, Renal Artery Injury Secondary to Blunt Abdominal Trauma – Two Case Reports, Polish Journal of Radiology, 10.12659/PJR.899710, 81, (572-577), (2016).
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.