J.LEE1, K.S.LEOW2, H.K.TAN1, A.KANNIVELU1, R.LOHAN1
Khoo Teck Puat Hospital1, Woodlands Health2
Management of renal trauma has evolved over the last few decades. With increasing recognition that operative management often ends in nephrectomy, advancements in imaging, angiographic techniques and minimally invasive interventions, there is now growing adoption of non-operative management for renal trauma, including high-grade renovascular injuries. We present three cases of high-grade renovascular injuries managed non-operatively with percutaneous angiographic interventions.
Three patients aged between 16 to 28 years presented with renovascular injuries. Two patients were injured due to a road traffic accident (Patient A and B), and one patient (Patient C) due to a sporting injury. All patients were haemodynamically stable. Computed tomography showed a Grade 5 injury with a truncated left renal artery in Patient A, and he underwent percutaneous renal artery revascularisation and stenting. Patients B and C sustained Grade 4 injuries with unilateral segmental renal artery injuries with active contrast extravasation. They both underwent percutaneous angiographic embolization.
All patients remained haemodynamically stable, with no evidence of further bleeding. No patient required laparotomy or nephrectomy. All patients recovered from their injuries and had normal serum creatinine. Follow-up CT urography in patient A 3 months after the trauma showed significant preservation of left renal function, as evidenced by substantial residual areas of renal parenchymal enhancement with symmetrical excretion of iodinated contrast. The stented left renal artery remained patent.
Non-operative management with percutaneous angiographic interventions is a potential alternative treatment in traumatic renal artery injury cases, with an acceptably high clinical success rate in preserving as much renal function as possible.