Lumbar Artery Pseudoaneurysm Following Renal Biopsy

Abstract

Lumbar artery pseudoaneurysms have previously been described as rare iatrogenic complications following percutaneous interventional procedures involving the flanks. We describe a case of a 71-year-old man who became unstable and dropped 3 grams of hemoglobin within 24 hours following renal biopsy. A post-biopsy hemorrhage was suspected, and a pseudoaneurysm of his second right lumbar (L2) artery was found on computed tomography angiogram (CTA). Successful coil embolization was performed in the right L2 artery. This case discusses the diagnostic and therapeutic challenges of this unusual complication as well as the anatomical and technical factors involved in the embolization of the lumbar arteries.

Lumbar Artery Pseudoaneurysms Presenting as a Novel Complication of Severe, Necrotizing Pancreatitis

“…Like our case, these patients require therapeutic anticoagulation, which can also increase risk of hemorrhage from pseudoaneurysms. Although most cases of lumbar artery pseudoaneurysms have been successfully managed with coil embolization, 3–8 treatment may involve a combination of endoscopy, radiology, and surgery to minimize risk of rebleeding and to reduce mortality. 9,12…”

“…10 Aside from 1 similar case, 11 lumbar artery pseudoaneurysms have only been reported in patients with spinal, paraspinal, or retroperitoneal surgery; biopsy of a retroperitoneal organ; or trauma (both blunt and penetrating). [3][4][5][6][7][8] Although endovascular angiography has the highest diagnostic yield 12 and coil embolization has improved success rates, recurrence of pseudoaneurysms and overall mortality remain high. 9 These patients often have multiple complications of pancreatitis, which may include splanchnic venous thrombosis.…”

“…Like our case, these patients require therapeutic anticoagulation, which can also increase risk of hemorrhage from pseudoaneurysms. Although most cases of lumbar artery pseudoaneurysms have been successfully managed with coil embolization, [3][4][5][6][7][8] treatment may involve a combination of endoscopy, radiology, and surgery to minimize risk of rebleeding and to reduce mortality. 9,12 Our case highlights a complicated disease course in a patient with biliary pancreatitis with severe peripancreatic necrosis, WON development, and no known history of risk factors of lumbar artery pseudoaneurysm formation.…”

“…10 Aside from 1 similar case, 11 lumbar artery pseudoaneurysms have only been reported in patients with spinal, paraspinal, or retroperitoneal surgery; biopsy of a retroperitoneal organ; or trauma (both blunt and penetrating). 3–8…”

“…2 Lumbar artery pseudoaneurysms are rare and most often associated with blunt or penetrating trauma, although even rarer cases have been reported in association with renal biopsy as well as other spinal and paraspinal procedures. [3][4][5][6][7][8] We present a rare case of lumbar artery pseudoaneurysms causing retroperitoneal hemorrhage as a complication of severe, necrotizing pancreatitis with peripancreatic walled-off necrosis (WON).…”