Case Report

Renal Artery Stenting for Intimal Flap Injury in a 2-Year-Old Child After Blunt Abdominal Trauma

Authors: Wesley Hsu, MD, Sally E. Mitchell, MD, Hyun S. Kim, MD

Abstract

Injury to the renal vasculature is an uncommon occurrence in the setting of blunt abdominal trauma. The authors report the case of a 2-year-old girl who developed occlusion from an intimal flap in a renal artery (grade IV renal injury) after blunt abdominal trauma that was treated with a stent placement. The stent procedure was technically successful in establishing renal artery flow. However, several months after the procedure, the patient developed stenosis within the stent and ultimately required a nephrectomy. To the authors' knowledge, this is the first report of percutaneous management of an acute intimal flap in a renal artery in a 2-year-old.


Key Points


* We illustrate that it is technically feasible to place an intravascular stent to repair an intimal flap in the renal artery of a pediatric patient.


* We seek to highlight the controversy in management of acute renal artery injury by reviewing both the literature on the efficacy of surgical repair as well as the limited literature on the use of stents to repair acute renal artery injury.


* We highlight the importance of clinical follow up for patients with injuries to the renal vasculature.

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References

1. Brown MF, Graham JM, Mattox KL, et al. Renovascular trauma. Am J Surg 1980;140:802–805.
 
2. Lock JS, Carraway RP, Hudson HC Jr., et al. Proper management of renal artery injury from blunt trauma. South Med J 1985;78:406–410.
 
3. Clark DE, Georgitis JW, Ray FS. Renal arterial injuries caused by blunt trauma. Surgery 1981;90:87–96.
 
4. Magilligan Jr. DJ, DeWeese JA, May AG, et al. The occluded renal artery. Surgery 1975;78:730–738.
 
5. Vollmar J, Helmstadter D, Hallwachs O. Complete occlusion of the renal artery: Nephrectomy or revascularization? J Cardiovasc Surg (Torino) 1971;12:441–446.
 
6. Bruce LM, Croce MA, Santaniello JM, et al. Blunt renal artery injury: incidence, diagnosis, and management. Am Surg 2001;67:550–554.
 
7. Haas CA, Sprinak JP. Traumatic renal artery occlusion: a review of the literature. Tech Urol 1998;4:1–11.
 
8. Whigham Jr. CJ, Bodenhamer JR, Miller JK. Use the Palmaz stent in primary treatment of renal artery intimal injury secondary to blunt trauma. J Vasc Interv Radiol 1995;6:175–178.
 
9. Villas PA, Cohen G, Putnam SG 3rd, et al. Wallstent placement in a renal artery after blunt abdominal trauma. J Trauma 1999;46:1137–1139.
 
10. Lee JT, White RA. Endovascular management of blunt traumatic renal artery dissection. J Endovasc Ther 2002;9:354–358.
 
11. Goodman DN, Saibil EA, Kodama RT. Traumatic intimal tear of the renal artery treated by insertion of a Palmaz stent. Cardiovasc Intervent Radiol 1998;21:69–72.
 
12. Dobrilovic N, Bennett S, Smith C, et al. Traumatic renal artery dissection identified with dynamic helical computed tomography. J Vasc Surg 2001;34:562–564.