Blunt Renal Artery Injury Research Articles

Endovascular Treatment of post-traumatic Renal Artery Dissection.

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.[1]
 The increased use of CT scans to evaluate blunt abdominal trauma identifies more acute renal artery injuries that may have gone undetected.[2]
 Patients with renal injury have limited options such as open surgical repair or anticoagulation.[3] The use of endovascular stents to treat trauma is a good option treatment. [4] 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.

Epidemiology and management of isolated blunt renal artery injuries.

Isolated blunt renal artery injury (BRAI) is uncommon. Treatment options include observation, nephrectomy, surgical reconstruction and endovascular stenting. Over the last decade, there has been an increasing use of angiointervention techniques in vascular trauma. Previous studies reported underutilization of endovascular stenting in BRAI, in favor of observation. The aim of this study was to examine the epidemiology and assess changes in the management of isolated BRAI over the last decade. Patients with BRAI identified from the National Trauma Data Bank (2016-2017). Deaths in the emergency department, transferral from outside hospital, and those with associated high-grade kidney injuries were excluded. Demographics, type of renal artery injury, and renal artery management were analyzed. Multivariate analysis was used to identify independent factors associated with isolated BRAI. During the study period, there were 1,708,076 patients with blunt trauma and 873 (0.05%) of them had BRAI. After exclusions, 563 patients with isolated BRAI who met the criteria for inclusion in the analysis. Auto versus pedestrian mechanism and male sex were associated with the highest risk for isolated BRAI. Comorbidities, such as hypertension or diabetes, were not associated with an increased risk of BRAI. Seatbelt use had a protective effect against BRAI. In the majority of patients (534, 95%), the renal artery injury was treated with observation, 23 (4%) with nephrectomy, 5 (0.9%) with endovascular stent and 1 (0.2%) with open renal artery repair. Among the 103 patients with isolated major renal artery laceration, 91.2% were treated with observation, 7.8% with nephrectomy and 1% with stenting. Isolated blunt renal artery trauma is rare. The vast majority of patients with BRAI is managed with observation with only a small number undergoing endovascular intervention. Endovascular stenting utilization has remained very low and has not changed in the last decade.

Long-Term Outcomes of Endovascular Stenting for Blunt Renal Artery Injuries with Stenosis: A Report of Five Consecutive Cases.

Renal artery stenting is performed for renal artery injuries to preserve renal function and prevent renovascular hypertension. However, its indications are controversial and its long-term prognosis remains unknown. Here, we evaluate the characteristics and long-term outcomes of renal artery stenting for blunt renal artery injuries at our institution. We retrospectively reviewed patients with blunt renal artery injuries who had been treated with stenting over a 12-year period at our institution. Five patients (three men and two women) were included. Trauma resulted from falls in three patients and motor vehicle accidents in two. All patients had experienced multiple injuries (median injury severity score, 24 [range, 16-48]; median revised trauma score, 5.9672 [4.0936-7.8408]; and median probability of survival, 0.689 [0.533-0.980]). All renal artery injuries involved stenosis because of traumatic arterial dissection or intimal tear; no cases of total occlusion were observed. No complications due to the intervention itself were observed. Although two patients developed reversible acute renal failure, none required long-term hemodialysis. One patient with renovascular hypertension was treated with antihypertensive agents for a month and subsequently became normotensive without further medication. All patients underwent postoperative computed tomography, which revealed no stent occlusion or renal atrophy. Renal scintigraphy for three patients demonstrated preserved differential renal function. All five patients survived. Renal artery stenting for hemodynamically stable blunt renal artery injuries with stenosis is suggested to be safe and helps in avoiding long-term hemodialysis and renovascular hypertension.

Percutaneous renal artery revascularization after prolonged ischemia secondary to blunt trauma: pooled cohort analysis.

We aimed to identify factors related to technical and clinical success of percutaneous revascularization for blunt renal arterial trauma. All cases of percutaneous revascularization for blunt renal arterial trauma were searched in the available literature. We included a case of iatrogenic renal artery occlusion at our institution treated by percutaneous stenting 20 hours after injury. A pooled cohort analysis of percutaneous revascularization for blunt renal artery injury was then performed to analyze factors related to technical and clinical success. Clinical failure was defined as development of new hypertension, serum creatinine rise, or significant asymmetry in split renal function. A total of 53 cases have been reported, and 54 cases were analyzed including our case. Median follow-up was 6 months. Technical success was 88.9% and clinical success was 75%. Of 12 treatment failures (25%), 66.7% occurred during the first postprocedure month. Time from injury to revascularization was not a predictor of clinical success (OR=1.00, P = 0.681). Renal artery occlusion was significantly associated with clinical failure (OR=7.50, P = 0.017) and postintervention antiplatelet therapy was significantly associated with treatment success (OR=0.16, P = 0.043). At 37-month follow-up, the stented renal artery in our case remained patent and the patient was normotensive with preserved glomerular filtration rate. Percutaneous revascularization for blunt renal arterial injury resulted in relatively high technical and clinical success. Time-to-revascularization was independent of successful outcomes. Clinical success was significantly associated with a patent renal artery at the time of intervention and with postprocedure antiplatelet therapy.

Acute posttraumatic renal artery dissection treated by primary stenting

Blunt renal artery injury is a relatively rare finding. The literature demonstrates an incidence as low as 0.08% of all blunt abdominal traumas, occurring in 1-4% of patients with renal injury. However, the rate of early diagnosis of such injuries is increasing due to increased awareness and the liberal use of contrast-enhanced computed tomography. In this report, we describe an approach to re-vascularization by endovascular stenting that resulted in successful salvage of renal function after blunt trauma.

Blunt renal artery injury treatment: changing perspectives a National Trauma Data Bank study

RESULTS: 157 patients completed the study. Average age was 39.2 12.7 and 65.0% were female. Comorbidities included: hypertension (10.2%), diabetes (6.4%) and asthma (5.7%). TBV and HGB values are reported. There was a significant drop in HGB in the crystalloid infused groups when compared to the preand postdonation HGB (p<0.0001). A formula was created to predict hemoglobin levels from a given estimated blood loss (EBL) and volume replacement (VR): Hemodilution HGB1⁄4(MeanPre-donation HGB e estimated hemorrhage HGB drop eestimated resuscitation HGB drop)1⁄4{MeanPre-donation HGB e [(EBL/TBV)*h] e [(VR/TBV)*r], h1⁄40.5521⁄4%TBV loss coefficient, r1⁄44.2641⁄4% TBV replacement coefficient.} Coefficients and means vary by sex and fluid used.

鈍的腎動脈損傷に対する腎動脈ステントの有用性と安全性－不完全閉塞5例への使用経験－

鈍的腎動脈損傷に対する腎動脈ステントの有用性と安全性－不完全閉塞5例への使用経験－

Blunt Renal Artery Injury in the Era of Endovascular Interventions

Blunt Renal Artery Injury in the Era of Endovascular Interventions

Delayed Traumatic Renal Artery Occlusion: Report of a Case

Traumatic renal artery injury is an unusual result of blunt trauma. No meaningful recommendation has been established for optimal management of blunt renal artery injury on account of a small number of cases. Early diagnosis, however, is important and advocated early management at present includes nephrectomy, revascularization, endovascular stenting, thrombolytic agent administration and careful observation of blunt renovascular injuries.A 60 year-old male suffered from a traffic accident when he drove a car and hit a telephone pole three days before. He was brought to the emergency department of a local hospital for first aid. He was then discharged to go home. However, gross hematuria was noted three days later and he came to our hospital. His vital signs were relatively stable at that time. (heart rate: 96/min, blood pressure 120/88mmHg, body temperature 36.7°C and respiratory rate: 18/min). Poor contrast perfusion in the left kidney was revealed on abdominal computed tomography. Dissecting injury of the renal artery was suspected. After performance of the first arteriography showing left renal artery occlusion, renal artery occlusion progressed and the lumen could not be identified during the second arteriography, which revealed total occlusion of the left renal artery. The patient received conservative therapy, and there was no further complication during his follow up at the outpatient department. Early diagnosis and early management will result in better recovery of the renal function. Computed tomography scan can be considered as the first choice of examination for diagnosis because of its high sensitivity and specificity.

A 10-year review of blunt renal artery injuries at an urban level I trauma centre

Introduction Little consensus exists over the management of high-grade renal injuries, with continued debate over observation versus invasive surgery. Blunt renal artery injury (BRAI) is a high-grade injury that may result in renal dysfunction, hypertension, or failure. Materials and methods Management of BRAI at a level I trauma centre during a decade was retrospectively reviewed to determine incidence, assess management strategy, and evaluate hospital outcomes. Data collected included demographics, injury details, standardised scoring, renal injury grade, haemodynamic stability, diagnostic modalities, medical interventions, mortality, and hospitalisation length. Results Thirty-eight BRAI patients (21 Grade IV and 17 Grade V injuries) were admitted, representing 0.16% of trauma admissions, and consisting primarily of young males. Ultrasonography and CT was performed in 92.1% and 76.3% of patients, respectively. Primary management included exploratory laparotomy in 42.9%, angiography and embolisation in 34.3%, and observation in 22.9%. Six nephrectomies and one revascularisation were performed. The incidence of BRAI and use of angiography are higher than those reported in previous studies. Conclusion Over the past decade, increased use of CT as a diagnostic tool for confirming renal injury in haemodynamically stable patients at our institution may have contributed to the increase in BRAI detection. Higher utilisation of angiography has enabled a more conservative approach. In this series, angiography had a success rate of 94.4%. Angiography and embolisation or observation with careful monitoring are viable management options in haemodynamically stable patients with isolated BRAI.

Management and Hospital Outcomes of Blunt Renal Artery Injuries: Analysis of 517 Patients from the National Trauma Data Bank

Management and Hospital Outcomes of Blunt Renal Artery Injuries: Analysis of 517 Patients from the National Trauma Data Bank

Management and hospital outcomes of blunt renal artery injuries: Analysis of 517 patients from the national trauma data bank

Management and hospital outcomes of blunt renal artery injuries: Analysis of 517 patients from the national trauma data bank

Management and Hospital Outcomes of Blunt Renal Artery Injuries: Analysis of 517 Patients from the National Trauma Data Bank

Blunt renal artery injuries are rare and no single trauma center can accumulate substantial experience for meaningful conclusions about optimal therapeutic strategies. The purpose of this study was to assess the incidence of renal artery injuries after different types of blunt trauma, and evaluate the current therapeutic approaches practiced by American trauma surgeons and the effect of various therapeutic modalities on hospital outcomes. This was a National Trauma Data Bank study including all blunt trauma admissions with renal artery injuries. Demographics, mechanism of injury, Injury Severity Score, Abbreviated Injury Score for each body area (head, chest, abdomen, extremities) injuries, type of management (nephrectomy, arterial reconstruction, or observation), time from admission to definitive treatment, and hospital outcomes (mortality, ICU, and hospital stay) were analyzed. Multiple and logistic regression analyses were used to examine the relationship between type of management and hospital outcomes. Of a total of 945,326 blunt trauma admissions, 517 patients (0.05%) had injuries to the renal artery. Of the 517 patients, the kidney was not explored in 376 (73%), 95 (18%) patients had immediate nephrectomy, and 45 (9%) patients underwent surgical revascularization. In 87 of 517 (17%) patients, renal artery injury was the only intraabdominal injury. Of the 87 patients with isolated renal artery injuries, 73 (84%) were observed, 7 (8%) underwent surgical revascularization, and 7 (8%) had early nephrectomy. Multiple regression analysis demonstrated that patients who had surgical revascularization had a considerably longer ICU and hospital stay than observed patients. Patients who had nephrectomy had a considerably longer hospital stay than observed patients. Blunt renal artery injury is rare. Nonoperative management should be considered as an acceptable therapeutic option.

Long-Term Results of Blunt Traumatic Renal Artery Dissection Treated by Endovascular Stenting

A 20-year-old man was admitted to the emergency department after falling 15 m onto the roof of a car and landing on his back. Imaging by computed tomography (CT) showed delayed perfusion of the right kidney and no excretion of contrast from that kidney on delayed images. Angiography confirmed a localized intimal dissection in the right main renal artery. We inserted a balloon-expandable stent using a transfemoral approach to successfully repair the dissection. At 4 year follow-up, Doppler ultrasound of the right renal artery and renal scintigraphy demonstrated preserved function of the right kidney. Our findings support endovascular stenting as a safe, effective and efficient treatment for blunt renal artery injury.

Blunt Renal Artery Injury: Incidence, Diagnosis, and Management

Renal artery injury is a rare complication of blunt abdominal trauma. Increasing use of CT scans to evaluate blunt abdominal trauma identifies more blunt renal artery injuries (BRAIs) that may have otherwise been missed. We identified patients with BRAI to examine the incidence and to evaluate the current diagnosis and management strategies. Patients admitted from 1986 to 2000 at a regional Level I trauma center sustaining BRAI were evaluated. Patients undergoing revascularization or nonoperative management were followed for renovascular hypertension. Twenty-eight patients with BRAI were identified out of 36,938 blunt trauma admissions between 1986 and 2000 (incidence 0.08%). Most renal artery injuries were diagnosed by CT scans (93%) with seven confirmatory angiograms. Nine patients had nephrectomy (one bilateral), and three patients with unilateral injuries were revascularized. Sixteen were managed nonoperatively including one patient who had endovascular stent placement. Three patients died from shock and sepsis. Follow-up for all patients ranged from one month to 8 years. Two patients developed hypertension: one who was revascularized (33%) and one was managed nonoperatively (6%). The frequency of diagnosis of BRAI is increasing because of the increased use of CT. Nonoperative management of unilateral injuries can be successful with a 6 per cent risk for developing renovascular hypertension. The role of endovascular stenting is promising, and further study is necessary.

Renal artery occlusion in pediatric blunt abdominal trauma--decreasing the delay from injury to treatment.

The cases of seven children treated from 1980 through 1991 with blunt renal artery injuries were reviewed to determine (1) if computed tomography alone could eliminate the need for intravenous pyelography (IVP) or arteriography (ART); and (2) the causes of management delays. The diagnosis of arterial occlusion was suggested by the lack of renal contrast enhancement in six patients with CT scans and in two patients with IVP. In three patients ART was merely confirmatory. The diagnosis was suggested by IVP or CT scan within a mean of 4.7 hours of injury, but ART added an additional mean 2.3 hours to the diagnostic workup. There was an additional 3.9-hour average delay in the operating room before revascularization. Six patients underwent revascularization. Four had minimal function by postoperative renal scans. Renal artery occlusion is rapidly detected by contrast-enhanced CT scanning without IVP or ART. The time period from diagnosis to revascularization must be expedited to improve renal outcome.