Renal artery pseudoaneurysm after partial nephrectomy: three case reports and a literature review

Abstract

Objectives: To report 3 cases of renal artery pseudoaneurysm (RAP) after partial nephrectomy and review the literature to discuss their unique presentation, clinical course, and management. RAPs are a rare clinical entity. They are a well-documented source of hemorrhage in association with renal biopsy, renal trauma, renal transplant, and percutaneous procedures; however, little is known about their presentation, pathophysiology, and management after nephron-sparing surgery.

Methods: Between 2000 and 2002, 698 partial nephrectomies were performed at our institution for treatment of suspected localized renal malignancy. A retrospective review of these cases revealed that 3 patients developed a postoperative RAP. These cases were reviewed along with the current medical literature available from the MEDLINE database to characterize this clinical entity further.

Results: Three patients developed RAP after 698 uncomplicated partial nephrectomies were performed (0.43% incidence). Illustrating a classic presentation, the patient in case 1 was successfully treated with selective embolization after presenting with symptoms 3 weeks postoperatively. The patient in case 2 was treated with elective partial selective embolization for an asymptomatic lesion that later resolved spontaneously. In case 3, the patient presented early during the hospital course and required urgent selective embolization.

Conclusions: RAP after nephron-sparing surgery is a rare, but potentially life-threatening, condition that is often difficult to diagnose and requires a high index of suspicion. Treatment should be tailored to each patient's clinical presentation to minimize morbidity and maximize renal conservation. All urologists should be aware of this potential postoperative complication and prepare accordingly.