Surgical treatment of distal renal artery expansive pseudoaneurysm after blunt trauma

Renal artery pseudoaneurysms are rare after blunt abdominal trauma. Pseudoaneurysms are caused by decelerating injuries of the renal artery after major falls or car accidents. Patients may be asymptomatic for months or years, and the pseudoaneurysm may expand and rupture before diagnosis or treatment. We report a case of distal renal artery pseudoaneurysm in a 51-year-old male patient, who had had a previous trauma while playing tennis 16 months ago. It was diagnosed by consecutive computed tomography-scans demonstrating a thrombosed pseudoaneurysm of the distal right renal artery, with progressive enlargement and involving persistent pain. Angiography showed right lower polar artery aneurysm and a small renal infarction due to a distal branch thrombosis. Open surgery was performed revealing a hole in a segmentary artery ostium, that was sutured with single stitches. The patient was discharged a few days late with normal renal function. Despite the development of endovascular techniques, sometimes surgical treatment is the only therapeutic alternative.