Blunt renal artery injury: Incidence, diagnosis, and management

Renal artery injury is a rare complication of blunt abdominal trauma. Incre asing use of CT scans to evaluate blunt abdominal trauma identifies more bl unt renal artery injuries (BRAIs) that may have otherwise been missed. We i dentified patients with BRAI to examine the incidence and to evaluate the c urrent diagnosis and management strategies. Patients admitted from 1986 to 2000 at a regional Level I trauma center sustaining BRAI were evaluated. Pa tients undergoing revascularization or nonoperative management were followe d for renovascular hypertension. Twenty-eight patients with BRAI were ident ified out of 36,938 blunt trauma admissions between 1986 and 2000 (incidenc e 0.08%). Most renal artery injuries were diagnosed by CT scans (93%) with seven confirmatory angiograms. Nine patients had nephrectomy (one bilateral ), and three patients with unilateral injuries were revascularized. Sixteen were managed nonoperatively including one patient who had endovascular ste nt placement. Three patients died from shock and sepsis. Follow-up for all patients ranged from one month to 8 years. Two patients developed hypertens ion: one who was revascularized (33%) and one was managed nonoperatively (6 %). The frequency of diagnosis of BRAI is increasing because of the increas ed use of CT. Nonoperative management of unilateral injuries can be success ful with a 6 per cent risk for developing renovascular hypertension. The ro le of endovascular stenting is promising, and further study is necessary.