Renal artery pseudoaneurysm occurring after laparoscopic partial nephrectomy

Renal artery pseudoaneurysm (RAP) is rare, and has been reported after renal biopsy and percutaneous renal surgery. We report a case of RAP after laparoscopic partial nephrectomy for renal cell carcinoma.     

Renal artery pseudoaneurysm following laparoscopic partial nephrectomy

PURPOSE: We describe the presentation, evaluation and management of hemorrhage due to renal artery pseudoaneurysm following laparoscopic partial nephrectomy. MATERIALS AND METHODS: Of the 345 laparoscopic partial nephrectomies performed by us during a 5-year period 6 patients (1.7%) had postoperative hemorrhage from a renal artery pseudoaneurysm. Patient charts were reviewed to identify pertinent preoperative, intraoperative and postoperative data. RESULTS: Median tumor size was 3.5 cm (range 2.2 to 5), intraoperative blood loss was 175 cc (range 50 to 500), warm ischemia time was 32 minutes (range 30 to 45) and operative time was 3.8 hours (range 2.5 to 5). The mean percent of kidney excised was 31% and pelvicaliceal system entry was suture repaired in all 6 patients. No patient required blood transfusion perioperatively. Average hospital stay was 3.4 days (range 2.5 to 6). Delayed postoperative hemorrhage occurred at a median of 12 days (range 8 to 15). Angiography revealed a renal artery pseudoaneurysm most commonly at a third or fourth order branch (4 and 2 patients, respectively). Percutaneous embolization was successful in each patient. CONCLUSIONS: Renal artery pseudoaneurysm is an uncommon complication following laparoscopic partial nephrectomy. These patients often present in delayed fashion. Selective angiographic embolization is the initial treatment of choice.     

Renal-artery pseudoaneurysm after laparoscopic partial nephrectomy

BACKGROUND AND PURPOSE: Laparoscopic partial nephrectomy (LPN) has emerged as a minimally invasive treatment for small renal masses. The most common complications include hemorrhage and urinary-fistula formulation. Renal-artery pseudoaneurysm has been described after open nephron-sparing surgery. We present two cases of renal-artery aneurysm following LPN. CASE REPORTS: Two patients with incidentally discovered renal masses underwent LPN with excellent hemostasis and presented in a delayed fashion with gross hematuria and flank pain. Both patients were treated with angiographic coil embolization, resulting in resolution of the pseudoaneurysms on postprocedure imaging. CONCLUSIONS: Renal-artery pseudoaneurysm is a potentially life-threatening complication of LPN. Patients present in a delayed fashion with gross hematuria, flank pain, or both. The treatment of choice is angiography with selective coil embolization.     

Renal artery pseudoaneurysm after laparoscopic partial nephrectomy for renal cell carcinoma in a solitary kidney

Abstract Renal artery pseudoaneurysms are a well‐documented complication following trauma or percutaneous urological procedures, but are rare after partial nephrectomy. We present the case of a 34‐year‐old woman who, after undergoing a left nephrectomy in childhood due to Wilms’ tumor, had a pseudoaneurysm in a solitary kidney after laparoscopic right partial nephrectomy with extraperitoneal approach for a renal cell carcinoma. The segmental renal artery feeding the pseudoaneurysm was embolized with coils without significant loss of residual renal function.     

Renal artery pseudoaneurysm after open partial nephrectomy: a case report

Although intraoperative hemorrhage is a well-recognized complication of open partial nephrectomy, postoperative hemorrhage caused by a renal artery pseudoaneurysm (RAP) after open partial nephrectomy is rare. We presented a case of RAP occurring in an 84-year-old man 3 weeks after right open partial nephrectomy for renal cell carcinoma. The pseudoaneurysmal branch was successfully identified and selectively embolized using percutaneous renal arterial angiography.     

Management of renal artery pseudoaneurysm after partial nephrectomy

Purpose  

Nephron sparing surgery has been established as a standard treatment for renal masses smaller than 4 cm in diameter. The benefit of nephron sparing surgery may be hampered by new types of complications. In particular, postoperative gross hematuria due to the formation of renal artery pseudoaneurysm (RAP) can lead to clinical significant hemorrhage. We retrospectively investigated the occurrence of postoperative RAP in our own consecutive series of open/laparoscopic partial nephrectomies requiring transarterial angioembolization.     

Transcatheter embolization of a renal artery pseudoaneurysm after open partial nephrectomy

Twelve days after an open partial nephrectomy, a 31-year-old man was re-admitted urgently for acute lumbar pain. An emergent helical computed tomography scan with intravenous contrast revealed a 3-cm renal artery pseudoaneurysm at the site of the partial nephrectomy, which was responsible for a large perirenal hematoma. Transarterial hyperselective embolization successfully occluded the pseudoaneurysm with less than 1 mL of N-butyl-2-cyanoacrylate, an embolizing agent less costly than coils. The kidney parenchyma was fully preserved.     

肾部分切除术后肾动脉假性动脉瘤形成的危险因素分析

目的 探讨肾部分切除术后发生肾动脉假性动脉瘤(RAP)的危险因素。 方法 2003年7月至2010年5月,肾细胞癌行肾部分切除术患者464例,术后发生RAP 5例(1.1％)。均为男性,左侧2例,右侧3例。对肾部分切除术的手术方法、RAP的临床表现、影像学特点及治疗进行回顾性分析。肿瘤的解剖学特征按照肾脏测量评分系统进行定量分析。 结果 5例RAP肾脏测量评分总分8 ～ 10分,属中、重度复杂性肿瘤。肿瘤直径3.6 cm,平均2.5 ～5.0 cm(直径评分1 ～2分)。4例呈外生性生长,其中3例≥50％肿瘤体积位于肾实质内（外生部分所占比例评分2分）,1例为完全内生性肿瘤（外生部分所占比例评分3分）。肿瘤与肾集合系统的距离均≤4 mm(距离集合系统或肾窦评分3分)。4例肿瘤跨越肾极线和（或）肾中轴线（位置与极线关系评分3分）,1例位于下极线下方（位置与极线关系评分1分）,但肿瘤靠近肾门。5例术后3 ～23 d,平均12 d,发生肉眼血尿和不同程度贫血,4例伴有背部疼痛,2例有明显低血容量表现,分别输血1000 ml和1800 ml。增强CT和选择性动脉造影检查显示RAP主要来源于肾段动脉分支。4例经超选择性动脉栓塞治愈（3例栓塞1次,1例2次）,1例栓塞治疗失败行患肾切除。随访12 ～30个月,平均21个月,5例肾功能正常,RAP无复发。 结论 肾部分切除术后迟发血尿的患者均应警惕RAP的可能性。肿瘤位置及其与肾段动脉分支的关系可能是发生RAP的危险因素。选择合适病例、仔细缝合血管断面和肾实质可减少RAP的发生。早期选择性动脉栓塞是RAP首选治疗方法。     

Conservative management of renal artery pseudoaneurysm following partial nephrectomy

A bleeding renal artery pseudoaneurysm is a recognised complication occurring after partial nephrectomy. The bleeding is usually suspected when a patient presents with haematuria following the procedure and the reported management is with radiologically guided embolisation. We report a case of renal artery pseudoaneurysm successfully managed conservatively, giving another potential management option in non-torrential haemorrhage.     

Embolization of a segmental renal artery pseudoaneurysm after partial nephrectomy in a solitary kidney

Renal pseudoaneurysms are a well-documented complication following trauma or after percutaneous biopsy. When symptomatic, patients present with hematuria and deteriorating renal function. We present the case of a 62-year-old man who, due to development of a pseudoaneurysm, presented with gross hematuria 10 days after partial nephrectomy for a renal cell carcinoma in a single kidney. A segmental artery was embolized with stainless steel coils without significant loss of the limited renal vascularization.     

Embolization of renal-artery pseudoaneurysm after laparoscopic partial nephrectomy for angiomyolipoma: case report and literature review

BACKGROUND: Renal-artery pseudoaneurysm (RAP) is a well-described complication of trauma or percutaneous urologic procedures. Delayed bleeding from an RAP is rare after partial nephrectomy. CASE REPORT: We present a 49-year-old woman who, 24 days after undergoing a laparoscopic right partial nephrectomy for a mesophytic 2.5-cm tumor, developed gross hematuria. Prompt CT imaging, followed by therapeutic angio-embolization of a third-order segmental renal artery with coils, treated the pseudoaneurysm successfully. CONCLUSIONS: Renal-artery pseudoaneurysm is a rare, potentially life-threatening, condition that often is difficult to diagnose and requires a high index of clinical suspicion. Early use of selective angio-embolization minimizes morbidity and maximizes renal conservation. The etiology, diagnosis, and management are discussed.