Self-Expanding Metallic Stent Placement for Renal Artery Dissection Due to Blunt Trauma

Abstract

Posttraumatic renal artery injury is rare and its management is still controversial. We report a case of traumatic renal artery stenosis that was managed using a selfexpanding metallic stent. CASE REPORT A 21-year-old woman was hospitalized with bilateral lung and liver contusions due to a traffic accident. At presentation the patient was in hypovolemic shock, and serum creatinine and blood urea nitrogen were 0.4 mg/dl (normal 0.5 to 1.1) and 28 mg/dl (8 to 20), respectively. Urinalysis revealed 15 red blood cells per high power field. Celiac arteriography showed prominent extravasation from branches of the left hepatic artery, which was successfully managed by transcatheter arterial embolization resulting in improvement of the hypovolemic shock. Although left renal arteriography demonstrated severe stenosis following dissection in the main trunk with impaired parenchymal perfusion, the patient was observed without treatment (fig. 1). The next day she became hypertensive (systolic pressure 140 to 160 mm Hg) and repeat left renal arteriography revealed that arterial dissection remained with significant mean pressure (25 mm Hg). After a 5Fr dual lumen aortic cannula (Cobra catheter, Cardeon Corp., Cupertino, California) was advanced into the narrowed true lumen over a hydrophilic guidewire (Radifocus, Terumo Corp., Tokyo, Japan), a self-expanding metallic stent (Wallstent [6 mm diameter, 30 mm length] Boston Scientific Scimed, Inc., Minneapolis, Minnesota) was placed into the stenotic artery. Satisfactory renal arterial caliber was established, and normal perfusion was recovered immediately after stent placement (fig. 2). Because active bleeding was not seen, the patient received 10,000 IU heparin daily for 48 hours, and subsequently cilostazol and aspirin for 3 months, which caused no drug induced hemorrhage. The systemic hypertension improved and the posttreatment level of plasma renin activity was normal at 1.8 ng/ml per hour. Computerized tomography showed adequate positioning of the endoprosthesis without impaired parenchymal perfusion. On day 11 renal scintigraphy using 99m technetium demonstrated that the effective renal plasma flow in the right and left kidney was 477.9 and 534.4 ml per minute, respectively. The patient was discharged home on postoperative day 15. DISCUSSION