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

PURPOSE We aimed to identify factors related to technical and clinical success of percutaneous revascularization for blunt renal arterial trauma. METHODS 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. RESULTS 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. CONCLUSION 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.


1. Haas CA, Dinchman KH, Nasrallah PF, Spirnak JP. Traumatic renal artery occlusion: a 15-year review. J Trauma 1998; 45:557-561.

2. Dowling JM, Lube MW, Smith CP, Andriole J. Traumatic renal artery occlusion in a patient with a solitary kidney: case report of treatment with endovascular stent and review of the literature. Am Surg 2007; 73:351-353.

3. Lopera JE, Suri R, Kroma G, Gadani S, Dolmatch B. Traumatic occlusion and dissection of the main renal artery: endovascular treatment. J Vasc Interv Radiol 2011; 22:1570-1574.

4. Sangthong B, Demetriades D, Martin M, et al. Management and hospital outcomes of blunt renal artery injuries: analysis of 517 patients from the National Trauma Data Bank. J Am Coll Surg 2006; 203:612-617.

5. 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.

6. The Joanna Briggs Institute. Joanna Briggs Institute Reviewers' Manual: 2016 edition. Australia: The Joanna Briggs Institute; 2016.

7. Whigham CJ, Jr., Bodenhamer JR, Miller JK. Use of the Palmaz stent in primary treatment of renal artery intimal injury secondary to blunt trauma. J Vasc Interv Radiol 1995; 6:175-178.

8. 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.

9. Paul JL, Otal P, Perreault P, et al. Treatment of posttraumatic dissection of the renal artery with endoprosthesis in a 15-year-old girl. J Trauma 1999; 47:169-172.

10. Villas PA, Cohen G, Putnam SG, 3rd, Goldberg A, Ball D. Wallstent placement in a renal artery after blunt abdominal trauma. J Trauma 1999; 46:1137-1139.

11. Lutkevich C, Hall JR, Lewis JV, Testerman GM, Westerfield L, Reeves WW. Percutaneous transluminal angioplasty of an acute traumatic renal artery occlusion. Tenn Med 2000; 93:140-141.

12. Merrot T, Portier F, Galinier P, et al. Trauma of the renal pedicle in children. Report of 2 cases of late revascularization with endovascular prosthesis. Prog Urol 2000; 10:277-281.

13. Mutze S, Laun R. Posttraumatic dissection of the renal artery--imaging diagnosis and interventional therapy. Rofo 2000; 172:717-718.

14. Bruce LM, Croce MA, Santaniello JM, Miller PR, Lyden SP, Fabian TC. Blunt renal artery injury: incidence, diagnosis, and management. Am Surg 2001; 67:550-556.

15. Dobrilovic N, Bennett S, Smith C, Edwards J, Luchette FA. Traumatic renal artery dissection identified with dynamic helical computed tomography. J Vasc Surg 2001; 34:562-564.

16. Delarue A, Merrot T, Fahkro A, Alessandrini P, Guys JM. Major renal injuries in children: the real incidence of kidney loss. J Pediatr Surg 2002; 37:1446-1450.

17. Lee JT, White RA. Endovascular management of blunt traumatic renal artery dissection. J Endovasc Ther 2002; 9:354-358.

18. Saidi A, Bocqueraz F, Sengel C, Descotes JL, Boillot B, Rambeaud JJ. Early revascularization by stent in renal pedicle trauma. Prog Urol 2003; 13:123-127.

19. Inoue S, Koizumi J, Iino M, Seki T, Inokuchi S. Self-expanding metallic stent placement for renal artery dissection due to blunt trauma. J Urol 2004; 171:347-348.

20. 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.

21. Flugsrud GB, Brekke M, Roise O. Endovascular stent in the acute treatment of blunt renal arterial injury. J Trauma 2005; 59:243-245.

22. Lupattelli T, Basile A, Iozzelli A, et al. Thrombolytic therapy followed by stenting for renal artery dissection secondary to blunt trauma. Emerg Radiol 2005; 11:164-166.

23. Memon S, Cheung BY. Long-term results of blunt traumatic renal artery dissection treated by endovascular stenting. Cardiovasc Intervent Radiol 2005; 28:668-669.

24. Hsu W, Mitchell SE, Kim HS. Renal artery stenting for intimal flap injury in a 2-year-old child after blunt abdominal trauma. South Med J 2006; 99:884-887.

25. Rha SW, Wani SP, Suh SY, et al. Images in cardiovascular medicine. Successful percutaneous renal intervention in a patient with acute traumatic renal artery thrombosis. Circulation 2006; 114:e583-585.

26. Sotelo T, Hairston J. Successful endovascular salvage for traumatic renovascular injury after eighteen hours. Internet J Urol 2006; 4.

27. Guillen G, Asensio M, Piro C, Martin JA, Perez M. Five years of renal trauma in a paediatric trauma center: new tools in the diagnostic and therapeutic process. Cir Pediatr 2007; 20:209- 214.

28. Breyer BN, Master VA, Marder SR, McAninch JW. Endovascular management of trauma related renal artery thrombosis. J Trauma 2008; 64:1123-1125.

29. Civy AM, Seguin P, Frouget T, Tanguy M, Heautot JF, Malledant Y. Bilateral traumatic dissection of the renal arteries. Ann Fr Anesth Reanim 2008; 27:727-730.

30. Schwartz JH, Malhotra A, Lang E, Sclafani SJ. One-year followup of renal artery stent graft for blunt trauma. J Urol 2008; 180:1507.

31. Bala M, Bloom AI, Appelbaum L, Levensart P, Rivkind AI. Early diagnosis of blunt renal artery injury and endovascular treatment. Isr Med Assoc J 2009; 11:571-572.

32. Trottier V, Lortie MA, Gouin E, Trottier F. Renal artery avulsion from blunt abdominal trauma in a horseshoe kidney: endovascular management and an unexpected complication. Can J Surg 2009; 52:e291-292.

33. Chabrot P, Cassagnes L, Alfidja A, et al. Revascularization of traumatic renal artery dissection by endoluminal stenting: three cases. Acta Radiol 2010; 51:21-26.

34. Kushimoto S, Shiraishi S, Miyauchi M, et al. Traumatic renal artery occlusion treated with an endovascular stent--the limitations of surgical revascularization: report of a case. Surg Today 2011; 41:1020-1023.

35. Simeone A, Demlow T, Karmy-Jones R. Endovascular repair of a traumatic renal artery injury. J Trauma 2011; 70:1300.

36. Springer F, Schmehl J, Heller S, Claussen CD, Brechtel K. Delayed endovascular treatment of renal artery dissection and reno-vascular hypertension after blunt abdominal trauma. Cardiovasc Intervent Radiol 2011; 34:1094-1097.

37. Vidal E, Marrone G, Gasparini D, Pecile P. Radiological treatment of renal artery occlusion after blunt abdominal trauma in a pediatric patient: is it never too late? Urology 2011; 77:1220- 1222.

38. Hatzinger M, Stastny M, Wirsam K, Sohn M. A bowling ball as the cause of a renal artery embolism. Aktuelle Urol 2012; 43:180-182.

39. Abu-Gazala M, Shussman N, Abu-Gazala S, et al. Endovascular management of blunt renal artery trauma. Isr Med Assoc J 2013; 15:210- 215.

40. Judd E, Lockhart ME, Rizk DV. Renovascular hypertension associated with pseudoaneurysm following blunt trauma. Am J Kidney Dis 2013; 62:839-843.

41. Thompson RH, Lane BR, Lohse CM, et al. Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol 2010; 58:340-345.

42. Hennequin LM, Joffre FG, Rousseau HP, et al. Renal artery stent placement: long-term results with the Wallstent endoprosthesis. Radiology 1994; 191:713-719.

Kaynak Göster

  • ISSN: 1305-3612
  • Yayın Aralığı: Yılda 6 Sayı
  • Başlangıç: 2001
  • Yayıncı: AVES Yayıncılık

4.7b 3.9b

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