Endovascular Treatment of Major Vessels Percutaneous Nephrostomy Misplacement

Abstract

Minimally invasive percutaneous treatment of urological diseases is daily increasing. Puncture, access to renal cavities and dilation the percutaneous tract is not a simple maneuver not free of complications. Percutaneous access of the kidney is sometimes mandatory such as drainage of distally obstructed kidneys in several situations like advanced tumors, stone-related situations and so others. Although the number of surgeries and the grade of specialization are rising, several complications like injuries to in-neighborhood organs, secondary sepsis or kidney bleeding may happen. The kidney is an extremely vascularized organ and this can facilitate vascular damage if some considerations are no taken into account previously. Major vessels (aorta artery and vena cava) damage is exceptional and generally require urgent surgery as in most penetrating injuries. A full endovascular treatment and repair in these situations is uncommon but possible. Initial misplacement of percutaneous nephrostomy tube (PNT) is not a frequent situation and when involving vessels, the small number of publications in literature mainly report catheter misplacement into the renal vessels or inferior vena cava, none affecting the aorta. This article presents two cases of misposition of PNT involving major vessels affecting vena cava and aorta artery. Both of them were successfully managed exclusively with endovascular treatment via femoral access.