Renal Artery Pseudoaneurysm Following Laparoscopic Partial Nephrectomy

Department of Urology, Montefiore Medical Center, Bainbridge, Bronx, New York, USA.
Urology (Impact Factor: 2.19). 08/2009; 74(4):819-23. DOI: 10.1016/j.urology.2009.03.056
Source: PubMed


To present our experience with the management of renal artery pseudoaneurysms following laparoscopic partial nephrectomy (LPN).
Our bi-institutional LPN database of 259 patients from July 2001 to April 2008 was queried for patients diagnosed with a postoperative renal artery pseudoaneurysm. Demographic data, perioperative course, complications, and follow-up studies in identified subjects were analyzed. Postembolization success was defined as symptomatic relief, resolution of hematuria, and a stable hematocrit and serum creatinine.
We identified 6 patients (2.3%) who were diagnosed with a renal artery pseudoaneurysm after LPN. The mean age of our cohort was 61.2 years (49-76), mean operative time was 208 minutes (140-265), and mean estimated blood loss was 408 mL (50-800). Patients presented at a mean of 12.6 days (5-23) after the initial surgery. Five patients had gross hematuria and a decreased hematocrit, with 1 patient presenting with clinical symptoms of hypovolemia. The sixth patient was incidentally diagnosed. The diagnosis of a renal artery pseudoaneurysm was confirmed in all cases by angiography. Selective angioembolization was successfully performed in all patients. At a median follow-up of 8.3 months all patients (100%) remained without any evidence of recurrence.
Although pseudoaneuryms are a rare postoperative complication of LPN, they are potentially life-threatening. Early identification and proper management can help reduce the potential morbidity associated with pseudoaneurysms. Our experience demonstrates the feasibility and supports the use of selective angioembolization as an excellent first-line option for patients who present with this form of delayed bleeding.

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    • "The vessel wall at the dilatation is thin and perforated that is prone to serious arterial damage and hemorrhage, making pseudoaneurysm a clinical emergency. Common causes of pseudoaneurysm are traumas (Farrell et al., 1996; Jebara et al., 1998; Weissbart et al., 2009), for example after surgery for cancer with fewer secondary renal artery pseudoaneurysms after kidney surgery (Albani and Novick, 2003; Treiber et al., 2003; Shapiro et al., 2009; Arroua et al., 2010; Netsch et al., 2010). Due to large blood flow in renal artery, once pseudoaneurysm is formed, it is prone to damages that can cause hemorrhage and endanger life. "
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    ABSTRACT: The aim of this study was to explore the angiographic diagnosis and embolization therapy for renal artery pseudoaneurysms due to acute urinary tract hemorrhage after conservative medical management failed. Seven out of ten cases had fever symptoms after the kidney surgery. The pseudoaneurysms were treated with gelatin sponge and (or) spring coil and the majority demonstrated rapid blockage of hemorrhage. Angiography diagnosis and trans catheter embolization are rapid, safe and effective methods for diagnosis and treatment of renal artery pseudoaneurysms.
    Preview · Article · Apr 2012 · Asian Pacific journal of cancer prevention: APJCP
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    • "Two unique complications that can arise in the postoperative setting are arteriovenous fistula and renal artery pseudo-aneurysm. The latter occurs in 1.7–2.4% of patients and tend to present 12 days after surgery [26] [27]. These complications often coexist and tend to precipitate from injury to proximal segmental renal arteries and veins. "
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    Full-text · Article · Mar 2012 · Arab Journal of Urology
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