Successful Management of a Rare Complication After Percutaneous Native Renal Biopsy

Abstract

Percutaneous renal biopsy is presumed to be a relatively safe procedure that is routinely performed to help in the diagnosis, prognosis and treatment of various renal parenchymal diseases. It is widely performed by interventional nephrologists and radiologists for certain indications. Here, we report a young man who developed a significant retroperitoneal hematoma and active bleeding due to left 12th intercostal artery injury after a native renal biopsy, with a concomitant renal segmental artery pseudoaneurysm. The bleeding was successfully treated by selective transcatheter arterial embolization with coils.

Lumbar Artery Pseudoaneurysm Following Renal Biopsy

“…A lumbar artery pseudoaneurysm is a rare complication that has been previously described following percutaneous nephrostomy and nephrolithotomy, vertebral biopsy, radical nephrectomy, and post-traumatic avulsion injuries [ 3 - 7 ]. Lumbar and intercostal artery pseudoaneurysms are a particularly unusual occurrence after a renal biopsy, with only a handful of case reports documented in the past [ 8 - 10 ]. The lumbar arteries (L1 to L4) are paired vessels that arise from the posterior aspect of the aorta at the level of transverse processes [ 5 ].…”

“…Angiography and embolization is a minimally invasive, quick technique that accurately localizes the bleeder and makes immediate therapeutic effect possible. It also avoids the risks involved with general anesthesia and has, therefore, been effectively used in the past for the successful treatment of lumbar artery pseudoaneurysms [ 3 - 4 , 6 - 8 ]. In our case, a transcatheter embolization successfully eliminated the pseudoaneurysm as well.…”

Endovascular management of a large retroperitoneal haemorrhage resulting from dual testicular and intra-renal arterial injury after renal biopsy

“…Source of haemorrhage is often intra-renal arteries, however, rarely lumbar, intercostal, and capsular arteries can be the source of haemorrhage. [ 3 4 5 6 ] Abed et al . reported a case of large retroperitoneal haemorrhage due to dual artery injury, where CTA showed two separate sources of haemorrhage due to intra-renal and subcostal artery injuries.…”

“…reported a case of large retroperitoneal haemorrhage due to dual artery injury, where CTA showed two separate sources of haemorrhage due to intra-renal and subcostal artery injuries. [ 5 ] Colic artery injury resulting in a large retroperitoneal haemorrhage after renal biopsy, is also reported. [ 7 ] Gonadal artery injury as source of haemorrhage after renal biopsy is extremely rare and not reported in the literature to the best of the author's knowledge.…”