Vascular and Interventional Radiology

Blunt Renal Trauma: Minimally Invasive Management with Microcatheter Embolization—Experience in Nine Patients

PURPOSE: To evaluate superselective embolization therapy for the management of arterial damage in patients with severe renal trauma.

MATERIALS AND METHODS: Nine consecutive patients with renovascular injuries after blunt trauma underwent superselective embolization. Six patients had pseudoaneurysms or traumatic arteriovenous fistulas. Three patients had frank, uncontained extravasation (two shattered kidneys, one complete pedicle avulsion) and were treated immediately after admission. Two patients were hemodynamically unstable. All patients underwent embolization with 3-F coaxial microcatheters and polyvinyl alcohol particles (n = 2) or 0.018-inch platinum microcoils (n = 7). Procedural and medical success and complications (eg, postembolization syndrome, abscess, permanent serum creatinine elevation, hypertension) were retrospectively assessed from the patients’ records. Mean clinical follow-up was 11.9 months (range, 1–50 months).

RESULTS: In all cases bleeding was effectively controlled with superselective embolization in a single session. There was no procedure-related loss of renal tissue in eight cases; in one patient, a lower pole remnant of 20% of viable ipsilateral parenchyma was lost due to the procedure. In one patient, a coil migrated into a lumbar artery without causing clinical consequences. None of the patients developed abscess, hypertension, or procedure-related impairment of renal function.

CONCLUSION: Superselective embolization may be used for effective, minimally invasive control of active renovascular bleeding.

© RSNA, 2002


  • 1 McAninch JW, Carroll PR, Klosterman PW, Dixon CM, Greenblatt MN. Renal reconstruction after injury. J Urol 1991; 145:932-937. Crossref, MedlineGoogle Scholar
  • 2 Kristjansson A, Pedersen J. Management of blunt renal trauma. Br J Urol 1993; 72:692-696. Crossref, MedlineGoogle Scholar
  • 3 Brandes SB, McAninch JW. Urban free falls and patterns of renal injury: a 20-year experience with 396 cases. J Trauma 1999; 47:643-649. Crossref, MedlineGoogle Scholar
  • 4 Carroll PR, Klosterman PW, McAninch JW. Surgical management of renal trauma: analysis of risk factors, technique, and outcome. J Trauma 1988; 28:1071-1077. Crossref, MedlineGoogle Scholar
  • 5 Velmahos GC, Demetriades D, Cornwell EE, III, et al. Selective management of renal gunshot wounds. Br J Surg 1998; 85:1121-1124. Crossref, MedlineGoogle Scholar
  • 6 Armenakas NA, Duckett CP, McAninch JW. Indications for nonoperative management of renal stab wounds. J Urol 1999; 161:768-771. Crossref, MedlineGoogle Scholar
  • 7 Altman AL, Haas C, Dinchman KH, Spirnak JP. Selective nonoperative management of blunt grade 5 renal injury. J Urol 2000; 164:27-30. Crossref, MedlineGoogle Scholar
  • 8 Danuser H, Wille S, Zoscher G, Studer U. How to treat blunt kidney ruptures: primary open surgery or conservative treatment with deferred surgery when necessary? Eur Urol 2001; 39:9-14. Crossref, MedlineGoogle Scholar
  • 9 Fisher RG, Ben Menachem Y, Whigham C. Stab wounds of the renal artery branches: angiographic diagnosis and treatment by embolization. AJR Am J Roentgenol 1989; 152:1231-1235. Crossref, MedlineGoogle Scholar
  • 10 Corr P, Hacking G. Embolization in traumatic intrarenal vascular injuries. Clin Radiol 1991; 43:262-264. Crossref, MedlineGoogle Scholar
  • 11 Miller KS, McAninch JW. Radiographic assessment of renal trauma: our 15-year experience. J Urol 1995; 154:352-355. Crossref, MedlineGoogle Scholar
  • 12 Moore EE, Shackford SR, Pachter HL, et al. Organ injury scaling: spleen, liver, and kidney. J Trauma 1989; 29:1664-1666. Crossref, MedlineGoogle Scholar
  • 13 Becker CD, Mentha G, Schmidlin F, Terrier F. Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. II. Gastrointestinal tract and retroperitoneal organs. Eur Radiol 1998; 8:772-780. Google Scholar
  • 14 Heyns CF, van Vollenhoven P. Increasing role of angiography and segmental artery embolization in the management of renal stab wounds. J Urol 1992; 147:1231-1234. Crossref, MedlineGoogle Scholar
  • 15 Angus LD, Tachmes L, Kahn S, Gulmi F, Gintautas J, Shaftan GW. Surgical management of pediatric renal trauma: an urban experience. Am Surg 1993; 59:388-394. MedlineGoogle Scholar
  • 16 Beaujeux R, Saussine C, al Fakir A, et al. Superselective endo-vascular treatment of renal vascular lesions. J Urol 1995; 153:14-17. Crossref, MedlineGoogle Scholar
  • 17 Perini S, Gordon RL, LaBerge JM, et al. Transcatheter embolization of biopsy-related vascular injury in the transplant kidney: immediate and long-term outcome. J Vasc Interv Radiol 1998; 9:1011-1019. Crossref, MedlineGoogle Scholar
  • 18 Dorffner R, Thurnher S, Prokesch R, et al. Embolization of iatrogenic vascular injuries of renal transplants: immediate and follow-up results. Cardiovasc Intervent Radiol 1998; 21:129-134. Crossref, MedlineGoogle Scholar
  • 19 Velmahos GC, Chahwan S, Falabella A, Hanks SE, Demetriades D. Angiographic embolization for intraperitoneal and retroperitoneal injuries. World J Surg 2000; 24:539-545. Crossref, MedlineGoogle Scholar
  • 20 Savastano S, Feltrin GP, Miotto D, Chiesura-Corona M. Renal aneurysm and arteriovenous fistula: management with transcatheter embolization. Acta Radiol 1990; 31:73-76. Crossref, MedlineGoogle Scholar
  • 21 Nash PA, Bruce JE, McAninch JW. Nephrectomy for traumatic renal injuries. J Urol 1995; 153:609-611. Crossref, MedlineGoogle Scholar
  • 22 Florack G, Sutherland DE, Ascherl R, Heil J, Erhardt W, Najarian JS. Definition of normothermic ischemia limits for kidney and pancreas grafts. J Surg Res 1986; 40:550-563. Crossref, MedlineGoogle Scholar
  • 23 Cass AS, Luxenberg M. Conservative or immediate surgical management of blunt renal injuries. J Urol 1983; 130:11-16. Crossref, MedlineGoogle Scholar
  • 24 Cass AS. Renovascular injuries from external trauma: diagnosis, treatment, and outcome. Urol Clin North Am 1989; 16:213-220. MedlineGoogle Scholar
  • 25 Husmann DA, Gilling PJ, Perry MO, Morris JS, Boone TB. Major renal lacerations with a devitalized fragment following blunt abdominal trauma: a comparison between nonoperative (expectant) versus surgical management. J Urol 1993; 150:1774-1777. Crossref, MedlineGoogle Scholar
  • 26 Christensen R. Invasive radiology for pediatric trauma. Semin Pediatr Surg 2001; 10:7-11. Crossref, MedlineGoogle Scholar
  • 27 Gupta M, Bellman GC, Smith AD. Massive hemorrhage from renal vein injury during percutaneous renal surgery: endourological management. J Urol 1997; 157:795-797. Crossref, MedlineGoogle Scholar
  • 28 Baron BJ, Scalea TM, Sclafani SJ, et al. Nonoperative management of blunt abdominal trauma: the role of sequential diagnostic peritoneal lavage, computed tomography, and angiography. Ann Emerg Med 1993; 22:1556-1562. Crossref, MedlineGoogle Scholar

Article History

Published in print: June 2002