Enhanced computed tomography after partial nephrectomy in early postoperative period to detect asymptomatic renal artery pseudoaneurysm

Abstract

We systematically examined the incidence and potential implications of renal artery pseudoaneurysm occurring after partial nephrectomy detected by computed tomography screening in the early postoperative period. Between January and December 2012, 117 patients underwent enhanced screening computed tomography on the fourth postoperative day after partial nephrectomy to evaluate for renal artery pseudoaneurysm. The size of the renal artery pseudoaneurysm and follow-up imaging were utilized to decide on pre-emptive angioembolization. Patient characteristics, tumor specifics and surgical data were analyzed. A total of 17 of 117 patients (15%) were found to have renal artery pseudoaneurysm on early postoperative computed tomography. Renal artery pseudoaneurysm occurred in nine of 73 open partial nephrectomy patients (12.3%) and eight of 44 laparoscopic partial nephrectomy patients (18.2%). One early patient experienced a postoperative bleed on postoperative day 9 after diagnosis of a 3.5-mm diameter renal artery pseudoaneurysm on postoperative day 3, and this patient was successfully managed with angioembolization. There were no other postoperative bleeding episodes. Rapid growth of a renal artery pseudoaneurysm was observed in a second patient who was treated with pre-emptive angioembolization. Five patients were diagnosed with small renal artery pseudoaneurysm (2-4 mm) on postoperative day 4 and observed with follow-up imaging showing resolution of the renal artery pseudoaneurysm. Another 10 patients were diagnosed with larger renal artery pseudoaneurysm (≥4 mm) and were managed with pre-emptive angioembolization. Early postoperative computed tomography screening is able to detect modest rates of asymptomatic renal artery pseudoaneurysm. The rate of postoperative bleed remained low with a policy of selective angioembolization. Renal artery pseudoaneurysm size and interval enlargement might indicate the risk of rupture. Further studies are required to assess the potential role of pre-emptive angioembolization.