Renal Arterial Pseudoaneurysm and Renal Arteriovenous Fistula Following Partial Nephrectomy

Abstract

Introduction: Renal arterial pseudoaneurysm (RAP) and renal arteriovenous fistula (RAVF) are rare but can cause fatal bleeding. Materials and Methods: A retrospective review was conducted for patients undergoing partial nephrectomy (PN) in our department. The clinical features and treatment methods were analysed, and the relationships between RAP/RAVF and the surgical methods and R.E.N.A.L. score were investigated. Results: Eleven patients were diagnosed with RAP/RAVF (9 with RAP and 2 with RAVF). The incidence of RAP/RAVF after laparoscopic PN showed no significant difference compared to that after open PN (p = 0.47). A low R.E.N.A.L. score was present in 6 patients, while an intermediate/high score was present in the other 5 patients. The major clinical manifestations included haematuria and haemorrhagic shock, and the median time of occurrence was 8 days after the operation. Six patients underwent an ultrasound examination. Of the 4 patients who underwent enhanced CT, 2 patients were diagnosed with RAP. All 11 patients were diagnosed by renal angiography and were cured after super-selective arterial embolization. The serum creatinine levels before and after embolization showed no significant differences (p = 0.14). Conclusions: RAP/RAVF may not have any relationship with the surgical procedure or R.E.N.A.L. score. Renal angiography and super-selective arterial embolization are the preferred methods for diagnosing and treating RAP/RAVF.

Management of iatrogenic renal arteriovenous fistula and renal arterial pseudoaneurysm by transarterial embolization

“…In this study, we found that RAP/RAVF occurred within 2 weeks after the operation in most of the patients (24/27, 88.9%), which was in agreement with the literature. [ 4 ] However, there was 1 case with RAP diagnosed 110 days after LPN. This result suggested that RAP/RAVF had a peak occurrence within 2 weeks after renal operation and could be diagnosed when it developed within a short time after renal surgery.…”

“…However, making the diagnosis of RAP/RAVF would be extremely difficult if the iatrogenic renal hemorrhage did not appear until 3 months or longer after renal surgery. [ 4 ] Therefore, it is worth noting that postdischarge follow-up would be essential to discover potentially unexpected hemorrhage, and RAP/RAVF should still be considered even a long time after the operation, especially when the patient experienced hematuria and flank pain.…”

“…[ 3 ] Literatures focusing on the endovascular management of RAP and RAVF have been sparse, with most series involved small number of patients. [ 4 ] We present clinical outcomes after TAE in a series of 27 patients with iatrogenic-induced RAP or RAVF.…”

Laparoscopic enucleation of renal masses

“…Occasionally, surgical reintervention for the suturing of the renal parenchyma or nephrectomy will be required, as occurred in one of the patients of the series. (24,25) Less complications have been reported when comparing PN to TE which is why it is recommended for treating localized tumors even for complex renal masses. (26) Other authors in TE studies have reported a similar behavior regarding the histological classification of the tumors: ccCR prevailed, followed by papillary and chromophobe carcinoma.…”

Delayed Presentation of Renal Arterio-Venous Fistula and Pseudoaneurysm in Native Left Kidney in Allograft Recipient: A Case Report

“…Prospective diagnosis of asymptomatic RAVF and RAP occurring beyond 3 months after the procedure is a difficult task since it is quite rare. 5 …”