Renal pseudoaneurysm: an overview

Abstract

Renal pseudoaneurysm is a rare vascular lesion that arises when an arterial injury within the kidney leads to contained hemorrhage. The associated hematoma forms outside the arterial wall and is typically surrounded by a layer of fibrous inflammatory tissue and blood clot. These lesions are unstable and their rupture can lead to life-threatening hemorrhage. Renal pseudoaneurysm has been reported to occur in various clinical scenarios, including after renal trauma, surgery and percutaneous procedures, as well as inflammatory and neoplastic processes within the kidney. Endovascular selective angioembolization is the mainstay of treatment, although surgery might be indicated when hemostasis and repair of the arterial wall defect are required. Percutaneous ultrasound-guided embolization is an additional option for patients with unfavorable vascular anatomy, or who cannot tolerate or have contraindications to the use of intravenous contrast agents. Some evidence suggests that these lesions can regress without intervention, although observation alone is not recommended as a management strategy in the vast majority of patients owing to the high risk of rupture. Evaluation and management of patients with renal pseudoaneurysm must take into account each individual's circumstances, due to the difficulty of accurately predicting the probability of spontaneous resolution or rupture.

Renal Artery Pseudoaneurysm in Kawasaki Disease

“…7 Angioembolization is the first-line treatment modality for renal artery pseudoaneurysms in both hemodynamically stable and unstable patients due to its efficacy and safety. 8 Even if the initial procedure fails, repeat endovascular attempts are often successful. 9 Other options include ultrasound-guided percutaneous injection of thrombin, endovascular stent placement, and surgical management.…”

Percutaneous injection of acrylic glue into renal allograft pseudoaneurysm for control of intractable post-biopsy hematuria

“…This has been successfully used for many years for endoluminal treatment of extra and intracranial vascular malformations. [3] The largest series of percutaneous embolization into renal pseudoaneurysm included 14 patients who were treated with direct injection of Gelfoam into aneurismal sac under USG guidance. [5] Thirteen patients had resolution of hematuria with no further intervention.…”

Renovascular Hypertension Associated With Pseudoaneurysm Following Blunt Trauma

“…2 In cases of blunt trauma, presentation can be delayed days to years after the injury, with the longest reported delay being 15 years. 17 This delay likely is explained by the new rapid expansion of a smaller, unrecognized, and previously contained pseudoaneurysm.…”

“…2 Reactive fibrosis occurs in the surrounding connective tissue encapsulating the hematoma, which forms a structure resembling an aneurysmal sac. A pseudoaneurysm is a serious condition because if the blood clot at the site of the arterial injury dissolves and re-establishes communication with the arterial lumen, this can result in pseudoaneurysmal expansion or rupture.…”

“…A pseudoaneurysm is a serious condition because if the blood clot at the site of the arterial injury dissolves and re-establishes communication with the arterial lumen, this can result in pseudoaneurysmal expansion or rupture. 2 …”