Renal Pseudoaneurysm with Associated Arteriovenous Fistula as a Cause of Delayed Bleeding after Percutaneous Nephrolithotomy: A Case Report and Current Literature Review

Abstract

Background: Pseudoaneurysm (PA) with associated arteriovenous fistula (AVF) is a rare delayed bleeding complication, occurring in less than 1% of patients after percutaneous nephrolithotomy (PNL). Case presentation. A 54-year-old man underwent PNL on February 28, 2023, for a large renal calculus in the right kidney lower pole, with postoperative delayed bleeding: macroscopic hematuria and bladder clot retention after 3 weeks. An iatrogenic PA and AVF were diagnosed after the failure of conservative measures. The patient was successfully treated with superselective angioembolization (SAE) under local anesthesia.

Conclusion: Late hemorrhagic complications after PNL can be severe. Rapid identification of a renal PA and AVF with SAE has a high success rate and low complication rate, avoiding prolonged hospitalization time and major renal surgery for this patient.

Figure 1

Contrast-enhanced abdominopelvic CT scan showing the arterial phase with contrast stain (green arrow) in the kidney right lower pole, hydronephrosis with hyperdense material in the pyelum, and bladder clot retention.

Figure 2

Angiography showing (a) peak opacification of the PA (green arrow) before embolization, (b) superselective catheterization at the base of the PA filled with contrast (green arrow) and the associated AVF with early venous return, and (c) successful obliteration of the feeder segmental artery with 4 Hilal Embolization MicroCoils™ (green arrow) with no residual filling of the PA on control angiography. PA = pseudoaneurysm; AVF = arteriovenous fistula.