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Endovascular treatment of renal artery pseudoaneurysm arising from the previously implanted renal artery stent

Mehmet Çelik1, Barkın Kültürsay1, Ayhan Küp1, Yusuf Yılmaz2, Ahmet Karaduman1, Gökhan Alıcı1

1Department of Cardiology, Kartal Koşuyolu Education and Research Hospital, Istanbul, Turkey

2Department of Cardiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey

Correspondence to:

Barkın Kültürsay, MD,

Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi,

Denizer caddesi Cevizli Kavşağı No. 2,

Kartal, İstanbul, Turkey,

phone: +90 554 638 30 37,

e-mail: bkultursay@gmail.com

Copyright by the Author(s), 2021

Kardiol Pol. 2021; 79 (12): 1391–1392; DOI: 10.33963/KP.a2021.0153

Received: August 8, 2021

Revision accepted: October 29, 2021

Published online: November 3, 2021

Renal artery pseudoaneurysm is a rare vascular complication related to percutaneous procedures, renal biopsy, nephrectomy, penetrating traumas, and more rarely blunt traumas [1]. It can present with palpable abdominal mass, flank and lower back pain, renal infarction, hematuria, and even death [2]. Sometimes, it is incidentally found during diagnostic procedures, such as abdominopelvic computed tomography or conventional angiography. In this case, we have a different predisposing factor for renal artery pseudoaneurysm: a renal artery stent. Herein we aim to present a case of isolated renal artery pseudoaneurysm that developed after renal artery stenting.

A 65-year-old male patient with a history of renal artery stent implantation (7.0 × 12 mm Carbofilm coated Radix2 stent [CID S.P.A]) due to left renal artery stenosis (Supplementary material, Video S1, S2) was referred to our department due to macroscopic hematuria. In the past medical history, there was no abnormality except right kidney atrophy and stenting of the left renal artery 3 years earlier. He had no recent history of intravenous contrast exposure or nephrotoxic drug use. Computed tomographic angiography was performed, and a left renal artery saccular pseudoaneurysm measuring 15 × 11 mm originating from the proximal part of the stent was detected (Figure 1A).

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During conventional renal angiography, it was observed that the left renal stent was open but focal dilatation of the left renal artery, originating from the proximal part of the stent in the left renal artery, attributed to pseudoaneurysm was detected (Figure 1B; Supplementary material, Video S3). Since untreated renal pseudoaneurysms are potentially life-threatening, the decision for intervention was made. Endovascular treatment is currently accepted as the first-line management of renal pseudoaneurysm in hemodynamically stable patients, as it is highly effective, safe, and unlikely to cause any long-term renal impairment [3]. Therefore, the patient underwent endovascular treatment. The pseudoaneurysm was reached with a 0.014-inch guidewire through the left renal artery stent. Corsair Pro microcatheter (ASAHI Intecc, Aichi, Japan) was advanced into the aneurysm via a guidewire. The pseudoaneurysmatic segment was occluded using 6 coils (Tornado, Cook, Bloomington, IN, USA) sizing 8 × 15, 7 × 30, 7 × 20, 6 × 20, 5 × 10, and 5 × 8 mm (Figure 1C; Supplementary material, Video S4). After successful coil embolization, selective left renal angiography showed minimal contrast passage into the pseudoaneurysm (Supplementary material, Video S4). The patient was then discharged, and the follow-up was uneventful for 3 months. At the third month’s visit, computed tomographic angiography demonstrated that the pseudoaneurysm was obliterated, and there was no contrast in the pseudoaneurysm segment (Figure 1D).

Renal artery pseudoaneurysm is a rare vascular lesion and is usually related to blunt trauma, deceleration injury, or urological interventions such as partial nephrectomy, percutaneous nephrolithotomy, renal biopsy-ureterorenoscopy for laser lithotripsy, and renal transplantation. Although these patients are clinically asymptomatic, clinical manifestations of these lesions include macroscopic hematuria, flank and lower back pain, hypertension and palpable abdominal mass [2].

We described a pseudoaneurysm of the renal artery that developed 3 years after renal artery stenting. Continued atherosclerotic process and hypertension following renal artery stenting may have led to the development of pseudoaneurysm. The appearance of a pseudoaneurysm has not previously been reported in the literature after renal artery stenting. Consequently, it should be kept in mind that, besides percutaneous interventions and traumas to the urinary system, pseudoaneurysm may also develop after renal artery stenting.

Supplementary material

Supplementary material is available at https://journals.viamedica.pl/kardiologia_polska.

Article information

REFERENCES

  1. 1. Shah S, Fatima A, Shah MD, et al. Post-PCNL renal artery pseudoanurysm. J Coll Physicians Surg Pak. 2018; 28(3): 238239, doi: 10.29271/jcpsp.2018.03.238, indexed in Pubmed: 29544585.
  2. 2. Hadjipavlou M, Abbaraju J, Serafimov V, et al. Spontaneous rupture of a renal artery pseudoaneurysm with no precipitating risk factor. JRSM Open. 2018; 9(4): 2054270418758568, doi: 10.1177/2054270418758568, indexed in Pubmed: 29707224.
  3. 3. Jubber I, Patel PR, Hori S, et al. Renal pseudoaneurysm: a rare and potentially fatal complication following ureteroscopy and laser fragmentation of stones. Ann R Coll Surg Engl. 2018; 100(3): e51e52, doi: 10.1308/rcsann.2017.0216, indexed in Pubmed: 29364018.

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