Renal artery pseudoaneurysm following laparoscopic partial nephrectomy.

Area of Science:

• Urology
• Vascular Surgery
• Interventional Radiology

Background:

• Renal artery pseudoaneurysms are uncommon but potentially life-threatening complications following laparoscopic partial nephrectomy (LPN).
• Delayed bleeding after LPN necessitates prompt diagnosis and effective management strategies.

Purpose of the Study:

• To report on the experience with managing renal artery pseudoaneurysms that occurred postoperatively after LPN.
• To evaluate the efficacy of selective angioembolization as a primary treatment modality.

Main Methods:

• A retrospective review of a bi-institutional database of 259 LPN patients was conducted.
• Six patients diagnosed with postoperative renal artery pseudoaneurysms were identified and their data analyzed.
• Successful management was defined by symptom resolution, cessation of hematuria, and stable hematocrit and creatinine levels.

Main Results:

• Six patients (2.3%) developed renal artery pseudoaneurysms after LPN, presenting a mean of 12.6 days post-surgery.
• Five patients presented with gross hematuria and decreased hematocrit; one had hypovolemia symptoms, and one was diagnosed incidentally.
• Angiography confirmed the diagnosis in all cases, and selective angioembolization was successfully performed in all patients with 100% resolution at median 8.3-month follow-up.

Conclusions:

• Renal artery pseudoaneurysms are rare but serious postoperative complications of LPN.
• Early identification and prompt management, such as selective angioembolization, are crucial for reducing morbidity.
• Selective angioembolization is a feasible and effective first-line treatment for delayed bleeding due to renal artery pseudoaneurysms post-LPN.