Renovascular Hypertension Associated With Pseudoaneurysm Following Blunt Trauma

Abstract

We present the case of a 21-year-old man who developed a renal artery pseudoaneurysm following a 7-foot fall onto his back. He initially presented with gross hematuria, left flank pain, and back pain. He was observed in the hospital for 3 days and discharged. One week later, he was readmitted with headache, nausea, vomiting, seizure activity, and hypertension. Contrast-enhanced computed tomography of the abdomen showed a left renal artery pseudoaneurysm with associated arterial narrowing and delayed ipsilateral renal enhancement. He underwent percutaneous stent-graft placement with resolution of the pseudoaneurysm. He was free of complications and normotensive off antihypertensive medications after 36 months of follow-up. Renal artery pseudoaneurysms are rare and under-recognized complications of blunt abdominal or back trauma that can cause hypertension. Imaging modalities in renovascular hypertension have focused on detecting renal artery stenosis from atherosclerotic disease or fibromuscular dysplasia, with little attention given to renal artery pseudoaneurysms. In addition, first-line treatment for renal artery pseudoaneurysms historically has consisted of angioembolization, yet percutaneous stent-graft placement has emerged as an attractive alternative to preserve vessel patency. We discuss the role of imaging in renovascular hypertension with a focus on renal artery pseudoaneurysms and their prevalence, diagnosis, and treatment.

Delayed and Chronic Sequelae of Trauma and the Role of the Interventional Radiologist

“…Treatment of the underlying vascular abnormalities with embolization can be effective and can be used to rule out this as the potential cause for hypertension. 1,54 Renal Pseudoaneurysm Urinoma together with PSA has been found in 12% of patients with renal traumatic injury undergoing follow-up imaging. 55 If left untreated, PSA can rupture leading to delayed hemorrhage presenting on average 2 to 5 days after penetrating trauma.…”

“…2 Long-term expansion of a PSA has been reported as a cause of hypertension, presenting 15 years posttrauma. 54 CT imaging with early and delayed phase should be used to assess injury and potential extravasation. Angiographic identification of the offending vessel, followed by embolization with coils or particulate, is the appropriate treatment.…”

Renal trauma management and current approaches /Bobrek travmalarina guncel yaklasimlar

“…Renal artery pseudo aneurysms are unusual complications of blunt abdominal or back trauma in renal injuries that can cause hypertension. If there is a past history of renal trauma, especially renovascular hypertension patients should be examined carefully in terms of renal artery pseudo aneurysms (37).…”

Blunt abdominal trauma. Kidneys injury. Part 3

“…Ложная посттравматическая артериальная анев-ризма [52,108] и артериовенозный свищ [102] явля-ются чрезвычайно редкими осложнениями консер-вативной терапии и требуют применения эндова-скулярных методов лечения.…”

“…Толь-ко сосудистые повреждения [56,74], артериальная аневризма [52] могут вызывать вазоренальную ги-пертонию, которая поддается консервативному ле-чению [98] или требует нефрэктомии [63].…”