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Nonsurgical Treatment of Acute Iatrogenic Renal Artery Injuries Occurring After Renal Artery Angioplasty and Stenting

¹ Department of Radiology, Patrick 1, Fletcher Allen Health Care, University of Vermont College of Medicine, 111 Colchester Ave., Burlington, VT 05401.

OBJECTIVE. The objective of this study was to determine the success of the nonsurgical treatment of acute iatrogenic renal artery injuries that occur after renal artery angioplasty and stenting at a tertiary referral center.

MATERIALS AND METHODS. During a 5-year period, 212 patients (308 renal arteries) underwent percutaneous transluminal angioplasty or stent dilatation of the renal artery. Through a retrospective review of medical and radiology records, we determined that 13 of these patients suffered iatrogenic renal artery injuries.

RESULTS. The renal arterial complication rates were 4.2% per artery treated and 6.1% per patient treated. All 13 patients were successfully treated nonsurgically. Five patients with acute rupture of the renal artery were treated immediately with balloon tamponade or with placement of an additional stent or stent-graft. Six patients suffered acute thrombotic occlusion; five were successfully treated with thrombolysis, and one was successfully treated without thrombolysis by the placement of an additional stent. Presumed distal guidewire perforation caused subcapsular hematoma in one patient and a perirenal and pararenal hematoma in another; both were successfully treated with conservative management. During the clinical follow-up period (mean period, 19 months), one patient required long-term hemodialysis. No other patients required additional treatment.

CONCLUSION. The nonsurgical treatment of acute iatrogenic renal artery injuries occurring after renal artery angioplasty and stenting can be successful and may obviate additional surgery.

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