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Review
. 2004 Jun;14(3):302-9; discussion 308.

[Traumatic dissection of the renal pedicle. Modalities of management in adults and children]

[Article in French]
Jean-Alexandre Long  1 , Arnaud Manel, Sébastien Penillon, Lionel Badet, Carmine Sessa, Jean-Luc Descotes, Christian Sengel, Jean-Jacques Rambeaud
Affiliations
  • PMID: 15373170
Review

[Traumatic dissection of the renal pedicle. Modalities of management in adults and children]

[Article in French]
Jean-Alexandre Long et al. Prog Urol. 2004 Jun.

Abstract

Objective: To evaluate the medium-term results of treatment for traumatic dissection of the renal arteries in a series of 12 cases and to propose emergency management based on recent endovascular revascularization techniques.

Material and methods: Between January 1999 and July 2003, 12 patients were admitted for closed trauma of the renal artery. There were 11 dissections with thrombosis and 1 intimal flap without distal thrombosis. Six patients were revascularized surgically (3 reno-renal bypass grafts, 3 auto-transplantations), 4 patients were treated by an endovascular procedure and 2 patients were treated conservatively with simple surveillance. Renal function, renal artery patency and blood pressure were evaluated immediately and at 3 months by clinical examination, Doppler ultrasound of the renal artery or CT angiography, and renal scintigraphy.

Results: In the group of 6 patients undergoing surgical revascularization (mean warm ischaemia time: 8 hours 30 minutes), 2 nephrectomies were performed (1 failure of revascularization, 1 sepsis in a non-functioning kidney). The other 4 patients presented negligible renal function on scintigraphy at 3 months despite patent renal arteries. Among the 4 patients undergoing endovascular revascularization (mean warm ischaemia time: 8 hours 50 minutes), 2 died from associated lesions and 2 had a non-functioning kidney (1 stent thrombosis, 1 silent kidney despite a patent renal artery). No cases of hypertension were observed regardless of the type of management.

Conclusion: Renal revascularization after thrombosis due to traumatic dissection of the renal artery must not be performed systematically after a warm ischaemia time of more than 4 hours in view of the poor recovery of renal function and the absence of morbidity associated with simple surveillance. When a procedure is performed, evaluation of the results must be based on morphological as well as functional parameters (scintigraphy).

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