Hospital: Hospital Universitario Puerta de Hierro.
Ciudad:
Nº:
Aut@r o Autores: M. Alfageme Zubillaga, P. García Benedito, S. Méndez Alonso, C. Cortés León, R.M. Ruíz Peralbo, P.M. Hernandez Guilabert.,
Presentación:
A 29 year old male who suffered a motorcycle accident was admitted to our emergency department. Findings on computed tomography (CT) imaging included left lung contusion, small spleen laceration, multiple pelvic fractures with retroperitoneal hematoma, very faint perfusion of the right kidney and absence of perfusión of left kidney.External fixation of pelvis fractures was performed. Subsequently, arteriography was done to evaluate both renal arteries, revealing total occlusion of the left vessel approximately 2cm from the aorta and practically complete occlusion of the rigth artery 3cm from the aorta. On the right artery the findings were compatible with dissection. An endovascular stent was deployed, and the patency of the right main renal artery was restored. However, the lower right pole was irrigated from a polar artery also ocluded.On the left artery, thrombotic segment was not passed with guidewires and couldnÁt be repermeabilized. The patient had good clinical evolution. At present he has chronic kidney disease (stage 3)
Discusión:
Major renal vascular injuries are uncommon, and the estimated incidence of renal artery injury among blunt trauma patients is only 0.08%. Blunt trauma to the renal artery can result in avulsion, laceration, or occlusion secondary to intimal injury with thrombosis (1). The severity of the injury is graded using the American Association for the Surgery of Trauma (AAST) Organ Severity Score varies from grades 1-5. Grade 5 renal vascular injuries involve injury to the main renal vein or artery.The diagnosis of traumatic vascular renal injuries is usually initially made by CT, as in our case. Angiography still remains the gold standard for confirmation and provides an opportunity for interventions, such as embolization, stenting, or catheter-directed thrombolysis. In our case, the patient had bilateral renal artery involvement. There were also no extra-renal injuries demonstrated on CT that required surgical exploration. Therefore the decision was made to proceed to rapid endovascular methods of attempted revascularization of the rigth kidney to preserve renal function (2).
Conclusión:
Major renal vascular injuries are uncommon, and the estimated incidence of renal artery injury among blunt trauma patients is only 0.08%. Blunt trauma to the renal artery can result in avulsion, laceration, or occlusion secondary to intimal injury with thrombosis (1). The severity of the injury is graded using the American Association for the Surgery of Trauma (AAST) Organ Severity Score varies from grades 1-5. Grade 5 renal vascular injuries involve injury to the main renal vein or artery.The diagnosis of traumatic vascular renal injuries is usually initially made by CT, as in our case. Angiography still remains the gold standard for confirmation and provides an opportunity for interventions, such as embolization, stenting, or catheter-directed thrombolysis. In our case, the patient had bilateral renal artery involvement. There were also no extra-renal injuries demonstrated on CT that required surgical exploration. Therefore the decision was made to proceed to rapid endovascular methods of attempted revascularization of the rigth kidney to preserve renal function (2).
Bibliografía:
– Jahangiri Y, Ashwell Z, Farsad K. Percutaneous renal artery revascularization after prolonged ischemia secondary to blunt trauma: pooled cohort analysis. Diagn Interv Radiol. 2017,23(5):371-8. – Loffroy R, Chevallier O, Gehin S, Midulla M, Berthod P-E,