A case of renal artery embolization for Grade 5 renal injury, usually reserved for surgery

IF 0.1 Q4 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
A. Hammond
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Abstract

Kidney trauma occurs in approximately 1%–5% of all traumas with the male preponderance. The consequences of blunt renal trauma range from a simple contusion or renal hematoma to complete shattering of the organ or avulsion of the vascular pedicle. Recently, there is more focus on conservative management as newer techniques evolve and its currently the preferred approach to most renal injuries; however, surgery is the main treatment modality for avulsion of the renal pelvis, injuries to the vascular pedicle, and life-threatening hemodynamic instability. Renal artery embolization is a minimally invasive procedure used in the management of many disease conditions and also to control hemorrhage. We report of a Grade 5 renal injury with hemodynamic instability managed with renal artery embolization which otherwise would have been managed with surgery. A 33-year-old presented with Grade 5 left renal injury and hemodynamic instability after a fall. Computed tomography of the abdomen after resuscitation showed shattered left kidney with disruption of the renal hilum and features suggestive of active bleeding. Due to the hypovolemic nature of the patient, embolization of the renal artery was requested. With anesthetic support and antibiotic cover, the right common femoral artery was punctured and a 5 French sheath inserted. Both left renal arteries were selectively catheterized and embolized to stasis with coils. An Angio-Seal device was deployed in the groin and no immediate complications seen. The patient was discharged few days after. This case report shows that Grade 5 renal artery can also be managed through a minimal invasive procedure to reduce the length of time at the hospital and also reduce the metabolic response of the patient.
肾动脉栓塞治疗5级肾损伤一例,通常留作手术用
肾脏创伤发生在大约1%-5%的创伤中,男性占主导地位。钝性肾损伤的后果从单纯的挫伤或肾血肿到器官完全粉碎或血管蒂撕脱。最近,随着新技术的发展,保守治疗越来越受到关注,目前保守治疗是大多数肾损伤的首选方法;然而,手术是治疗肾盂撕脱伤、血管蒂损伤和危及生命的血液动力学不稳定的主要方式。肾动脉栓塞是一种微创手术,用于治疗许多疾病和控制出血。我们报告了一例5级肾损伤,血流动力学不稳定,通过肾动脉栓塞治疗,否则可以通过手术治疗。一名33岁的患者跌倒后出现5级左肾损伤和血液动力学不稳定。复苏后腹部的计算机断层扫描显示左肾粉碎,肾门破裂,特征提示活动性出血。由于患者的低血容量性,要求对肾动脉进行栓塞治疗。在麻醉支持和抗生素覆盖的情况下,穿刺右股总动脉并插入5根法国鞘。两条左肾动脉都被选择性地插入导管,并用线圈栓塞至淤滞状态。在腹股沟植入Angio-Seal装置,未发现立即并发症。病人几天后出院了。该病例报告显示,5级肾动脉也可以通过微创手术进行管理,以缩短住院时间,并降低患者的代谢反应。
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来源期刊
West African Journal of Radiology
West African Journal of Radiology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
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