-Case Reports-

Long-Term Outcomes of Endovascular Stenting for Blunt Renal Artery Injuries with Stenosis: A Report of Five Consecutive Cases

Ichiro Okada¹, Junichi Inoue², Hiroshi Kato³, Yuichi Koido¹, Nobuaki Kiriu¹, Takayuki Hattori⁴, Kohei Morimoto⁵, Yoshiaki Ichinose⁵ and Hiroyuki Yokota⁶

¹Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tokyo, Japan
²Emergency and Critical Care Medical Center, Yamanashi Prefectural Central Hospital, Yamanashi, Japan
³Department of Emergency Medicine, Minamitama Hospital, Tokyo, Japan
⁴Department of Radiology, Tokyo Metropolitan Health and Medical Treatment Corporation Ohkubo Hospital, Tokyo, Japan
⁵Department of Radiology, National Hospital Organization Disaster Medical Center, Tokyo, Japan
⁶Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan

Background: Renal artery stenting is performed for renal artery injuries to preserve renal function and prevent renovascular hypertension. However, its indications are controversial and its long-term prognosis remains unknown. Here, we evaluate the characteristics and long-term outcomes of renal artery stenting for blunt renal artery injuries at our institution.
Methods: We retrospectively reviewed patients with blunt renal artery injuries who had been treated with stenting over a 12-year period at our institution. Five patients (three men and two women) were included.
Results: Trauma resulted from falls in three patients and motor vehicle accidents in two. All patients had experienced multiple injuries (median injury severity score, 24 [range, 16-48]; median revised trauma score, 5.9672 [4.0936-7.8408]; and median probability of survival, 0.689 [0.533-0.980]). All renal artery injuries involved stenosis because of traumatic arterial dissection or intimal tear; no cases of total occlusion were observed. No complications due to the intervention itself were observed. Although two patients developed reversible acute renal failure, none required long-term hemodialysis. One patient with renovascular hypertension was treated with antihypertensive agents for a month and subsequently became normotensive without further medication. All patients underwent postoperative computed tomography, which revealed no stent occlusion or renal atrophy. Renal scintigraphy for three patients demonstrated preserved differential renal function. All five patients survived.
Conclusions: Renal artery stenting for hemodynamically stable blunt renal artery injuries with stenosis is suggested to be safe and helps in avoiding long-term hemodialysis and renovascular hypertension.

J Nippon Med Sch 2019; 86: 172-178

Keywords
blunt renal artery injury, stenosis, endovascular treatment, hemodialysis, renovascular hypertension

Correspondence to
Ichiro Okada, MD, Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midoricho, Tachikawa, Tokyo 190-0014, Japan
ichiroh1974@gmail.com

Received, March 10, 2017
Accepted, December 12, 2018