Angiographic embolization of renal stab wounds

Nonoperative management of renal stab wounds following complete radiographic assessment has become an accepted if not preferred therapeutic option. Selected injuries, however, including renal artery branch injuries, often require surgical intervention and result in partial or total nephrectomy. We report our experience with 16 renal branch arterial injuries secondary to street stabbing during the last 10 years that were managed with angiography and embolization techniques. Angiography with embolization was the initial treatment in 11 patients, while 5 had undergone emergency surgical intervention initially because of hemodynamic instability. Subsequently, gross hematuria recurred in the latter 5 patients and they were managed angiographically. Overall, 14 of 16 patients had prompt hemostasis documented either on the post-embolization angiogram or by clinical assessment. In 2 patients bleeding was increased but partial nephrectomy ultimately was required. Complications included nontarget embolization in 2 patients: 1 subsequently had hypertension and 1 had no untoward effect as a result of this complication. We conclude that angiography with transcatheter embolization techniques provides a safe and effective means of managing renal artery branch injuries secondary to stab wounds.