Case – Renal artery pseudoaneurysm: A life-threatening occurrence following thulium laser lithotripsy

Introduction Renal artery pseudoaneurysm post-laser lithotripsy is a rare and potentially life-threatening complication. Traditionally, the most common modalities used for treatment of urinary tract stones were holmium laser lithotripsy and extracorporeal shockwave lithotripsy. However, thulium laser has recently gained momentum in the treatment of urinary tract stones with increasing use and availability in healthcare systems. We report a case of renal artery pseudoaneurysm post-thulium laser lithotripsy who presented in hemorrhagic shock after ureteral stent removal and was subsequently stabilized by endovascular embolization.

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Endovascular management of a large renal artery aneurysm: a case report and review of the literature

BMC Urology ◽

10.1186/s12894-021-00877-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Alec Zhu ◽

Peter Connolly ◽

A. Ari Hakimi

Keyword(s):

Interventional Radiology ◽

Case Report ◽

Renal Artery ◽

Renal Mass ◽

Artery Aneurysm ◽

Endovascular Embolization ◽

Surgical Approaches ◽

Renal Artery Aneurysm ◽

Artery Pseudoaneurysm ◽

Renal Artery Pseudoaneurysm

Abstract Background A renal artery aneurysm is a rare clinical presentation that can be found incidentally on imaging or during workup for refractory hypertension. Its presentation can be similar to that of a renal artery pseudoaneurysm, but the etiologies of the two vascular lesions differ. We present a patient who had an incidental finding of a large renal artery aneurysm that was managed with endovascular embolization. We also describe the literature surrounding the etiology, presentation and management of both renal artery aneurysms and renal artery pseudoaneurysms. Case presentation A 62-year-old man was referred to a urologic oncologist for workup of a newly found renal mass. Initial imaging with computed tomography showed a homogenous, well-circumscribed mass arising from the right kidney. Further evaluation with Doppler ultrasonography demonstrated pulsatile flow within the renal mass that was concerning for a renal artery pseudoaneurysm. The patient initially underwent a diagnostic angiogram by interventional radiology and was found to have a true renal artery aneurysm. Interventional radiology considered placement of a covered stent or angioembolization, but treatment was deferred due to concern for compromising the patient’s renal function. Patient was subsequently transferred to a neighboring hospital for management by vascular surgery. After considering both open surgical and endovascular approaches, the patient ultimately underwent angioembolization of the renal artery aneurysm. Short-term follow-up showed successful exclusion of the aneurysm with minimal adverse effects to the patient. Conclusions Our case report documents a unique case of an incidentally found large renal artery aneurysm that was successfully managed with endovascular embolization. Renal artery aneurysms and renal artery pseudoaneurysms, which can present similarly on imaging, are important diagnostic considerations in a patient presenting with a new renal mass. While open surgical approaches can be used to repair aneurysms, endovascular approaches using stenting or angioembolization are safe and effective options for treating renal aneurysms and renal pseudoaneurysms.

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Treatment of upper urinary tract stones with flexible ureteroscopy in children

Canadian Urological Association Journal ◽

10.5489/cuaj.5283 ◽

2018 ◽

Vol 13 (3) ◽

Cited By ~ 1

Author(s):

Jing Xiao ◽

Xiangyu Wang ◽

Jun Li ◽

Miaomiao Wang ◽

Tiandong Han ◽

...

Keyword(s):

Urinary Tract ◽

Operation Time ◽

Upper Urinary Tract ◽

Laser Lithotripsy ◽

Holmium Laser ◽

Flexible Ureteroscopy ◽

Holmium Laser Lithotripsy ◽

Stone Free Rate ◽

Urinary Tract Stones ◽

Free Rate

Introduction: This single-centre, retrospective study aimed to assess the efficacy and safety of flexible ureteroscopy (FURS) combined with holmium laser lithotripsy in treating children with upper urinary tract stones. Methods: From June 2014 to October 2015, a total of 100 children (74 boys and 26 girls) with upper urinary tract stones were treated using FURS. A 4.7 Fr double-J stent was placed two weeks before operation. Patients were considered stone-free when the absence of residual fragments was observed on imaging studies. The preoperative, operative, and postoperative data of the patients were retrospectively analyzed. Results: A total of 100 pediatric patients with a mean age of 3.51±1.82 years underwent 131 FURS and holmium laser lithotripsy. Mean stone diameter was 1.49±0.92 cm. Average operation time was 30.8 minutes (range 15–60). The laser power was controlled between 18 and 32 W, and the energy maintained between 0.6 and 0.8 J at any time; laser frequency was controlled between 30 and 40 Hz. Complications were observed in 69 (69.0 %) patients and classified according to the Clavien system. Postoperative hematuria (Clavien I) occurred in 64 (64.0 %) patients. Postoperative urinary tract infection with fever (Clavien II) was observed in 8/113 (7.1%) patients. No ureteral perforation and mucosa avulsion occurred. The overall stone-free rate of single operation was 89/100 (89%). Stone diameter and staghorn calculi were significantly associated with stone-free rate. Conclusions: FURS and holmium laser lithotripsy is effective and safe in treating children with upper urinary tract stones.

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Intraparenchymal Renal Artery Pseudoaneurysm and Arteriovenous Fistula on a Solitary Kidney Occurring 38 Years after Blunt Trauma

Case Reports in Urology ◽

10.1155/2017/3017501 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Daniel Benamran ◽

Benedicte de Clippele ◽

Frank Hammer ◽

Bertrand Tombal

Keyword(s):

Renal Artery ◽

Arteriovenous Fistula ◽

Blunt Trauma ◽

Left Kidney ◽

Solitary Kidney ◽

Endovascular Embolization ◽

Artery Pseudoaneurysm ◽

Kidney Trauma ◽

Renal Artery Pseudoaneurysm

Pseudoaneurysm and arteriovenous fistulae of the renal artery are rare complications of kidney trauma. They commonly result from open traumas and occur within days after the injury. Common symptoms include acute haematuria, pain, or hypertension. We report the case of a fifty-three-year-old man presenting with symptomatic complex chronic high flow kidney arteriovenous fistula with interposition of a pseudoaneurysmal pouch and arterial aneurysmal dilatation in a solitary left kidney 38 years after a blunt trauma. Those conditions were successfully treated by endovascular embolization followed by regular radiologic, biological, and clinical follow-up. To the best of our knowledge, few similar cases were reported more than 20 years after trauma. However, no case combining an arteriovenous fistula and a pseudoaneurysm revealing as late as 38 years after trauma was found. In addition, management of those conditions on a solitary kidney and outcomes has not been described. We believe that our case depicts the clinical presentation and management of this rare entity that should not be unrecognized due to its potential lethal implications.

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Renal artery pseudoaneurysm of infectious etiology: A life-threatening complication after renal transplantation

Urology ◽

10.1016/j.urology.2006.04.017 ◽

2006 ◽

Vol 68 (3) ◽

pp. 668-669 ◽

Cited By ~ 9

Author(s):

Christopher Y.C. Nguan ◽

Patrick P.P.W. Luke

Keyword(s):

Renal Transplantation ◽

Renal Artery ◽

Artery Pseudoaneurysm ◽

Life Threatening ◽

Renal Artery Pseudoaneurysm ◽

Life Threatening Complication ◽

Infectious Etiology

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Renal artery pseudoaneurysm successfully treated with the outer coating of the tip of the J wire

Vascular ◽

10.1177/1708538112472281 ◽

2013 ◽

Vol 22 (1) ◽

pp. 61-64

Author(s):

Fadi Tannouri ◽

Rina Maalouly ◽

Jean F Salem ◽

Fadi Haddad

Keyword(s):

Renal Artery ◽

Blunt Abdominal Trauma ◽

Renal Injury ◽

Guide Wire ◽

Kidney Injury ◽

Artery Pseudoaneurysm ◽

Endovascular Interventions ◽

Life Threatening ◽

Renal Artery Pseudoaneurysm ◽

Outer Coating

Kidney injury and renal pseudoaneurysm after blunt abdominal trauma can lead to renal loss and potentially life-threatening bleed. Recent advances in endovascular interventions (embolization) can prevent potentially challenging surgical situations. We are presenting herein a case of life-threatening renal injury with renal artery pseudoaneurysm and bleeding treated with makeshift embolization using the outer coating of a J tip guide wire.

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A rare case of spontaneous rupture of renal artery pseudoaneurysm in a previously hypertensive patient

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh210303080s ◽

2021 ◽

pp. 80-80

Author(s):

Dejan Stevanovic ◽

Nebojsa Mitrovic ◽

Damir Jasarovic ◽

Aleksandar Lazic ◽

Branko Lukic

Keyword(s):

Renal Artery ◽

Systemic Disease ◽

Hypovolemic Shock ◽

Retroperitoneal Hematoma ◽

Prior History ◽

Renal Surgery ◽

Artery Pseudoaneurysm ◽

Intraperitoneal Hemorrhage ◽

Life Threatening ◽

Renal Artery Pseudoaneurysm

Introduction. The renal artery and segmental renal artery pseudoaneurysm is a rare and usually asymptomatic vascular lesion which in most of the cases thrombose spontaneously, but at same time it can be a source of life-threatening hemorrhage and shock. Today, these pseudoaneurysms are discovered with increasing frequency due to unrelated abdominal imaging or on screening work-ups for hypertension, as well as widespread use of angiography. Typically, they are seen in patients after trauma, inflammation, or renal surgery or biopsy. Case outline. In our case, a 52-year-old male patient with no prior history of surgery, significant abdominal trauma and systemic disease, presented with left flank pain and signs of hypovolemic shock that manifested before the admission in the surgical emergency room. The CT scan promptly demonstrated rupture of large retroperitoneal hematoma with the massive intraperitoneal hemorrhage. The angiography confirmed the rupture of the renal artery pseudoaneurysm. The patient had the urgent operation. A life-saving nephrectomy was performed while intraperitoneal hemorrhage and retroperitoneal hematoma was evacuated. The fourteen days after surgery the patient was discharged fully recovered, with normal diuresis and serum levels of creatinine and urea within referential values. During the period of hospitalization, he was diagnosed and treated hypertension. Conclusion. Rupture of pseudoaneurysms with the following hemorrhage into the intraperitoneal cavity and retroperitoneum is a life-threatening condition, as proven with this case in which hypovolemic shock manifested before the admission. We would like to highlight the importance of high blood-pressure control and the importance of regular check-ups.

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