UROGENITAL TRAUMA

Self-expanding metallic stent placement for renal artery dissection due to blunt trauma
Inoue S, Koizumi J, Iino M, Seki T, Inokuchi S
Department of Emergency Medicine, Tokai University School of Medicine, Isehara
City, Kanagawa, Japan
J Urol. 2004; 171: 347-8

• Case Report: No abstract available
  
  
• Editorial Comment
  Reports in the literature concerning the successful treatment of blunt renal artery injury with endovascular methods are rare (3 cases in the literature). Endovascular treatments are very tempting, because open repair can be both dangerous and futile, with a high rate of post-surgical thrombosis. Also, most patients with open arterial repairs would be treated with anticoagulants to decrease the potential for postoperative thrombosis, although this is often not possible in a trauma population. The authors of this case report discuss a patient with a traumatic intimal tear of the renal artery which caused both renal hypoperfusion and renovascular hypertension, who was treated with placement of a wallstent in the artery. Renal perfusion improved immediately and the hypertension subsided. The authors gave heparin 10,000 IU for 48 hours followed by aspirin and the phosphodiesterase III inhibitor (cilostazol) for 3 months. The patient suffered no bleeding, which was surprising as she had liver and bilateral lung contusions. Although these authors show that endovascular treatment of significant traumatic renal artery stenosis is possible I believe that (although tempting) it likely remains impractical for the majority of out trauma patients whom we are unwilling to fully anticoagulate after their injury. Interventional radiology physicians also remain wary of placing stents in injured vessels because of the concern of artery rupture or stent migration, causing catastrophic bleeding (although these authors advocate both endoluminal ultrasound and the use of a long stent to make sure the entire injured portion is stented properly). Perhaps the future will bring an endoluminal arterial stent technology that won’t require systemic anticoagulation. Until then, this potentially risky treatment will remain experimental at best.

Dr. Richard A. Santucci
Assistant Professor of Urology
Wayne State University
Detroit, Michigan, USA