Successful interventional treatment of post-biopsy renal artery pseudoaneurysm in pediatric patients

With an incidence ranging from 0.01% to 1.0%, renal artery pseudoaneurysm (RAP) is a rare complication after renal biopsy, percutaneous renal surgery, penetrating trauma, and rarely blunt renal trauma.

Percutaneous renal biopsy (PRB) of native kidneys was performed in 1,500 pediatric patients under real-time ultrasonographic guidance at our institution from July 1999 to January 2011. A retrospective review of these cases revealed that 2 patients developed a post-biopsy RAP. The diagnosis of RAP was established using color duplex ultrasonography (US), contrast-enhanced computed tomography (CT) and digital substraction angiography (DSA).

Two patients developed RAP after 1,500 PRBs were performed (0.13% incidence). In the presented cases, immediate post-bioptic ultrasound showed no abnormalities. A high index of suspicion for RAP was prompted when complications such as unexplained gross hematuria and anemia occurred and the arterial phase of CT showed a well-circumscribed hyperdense area with a contrast enhancement similar to the adjacent arterial vessels. The diagnosis was confirmed by DSA and then the feeding artery of RAP was successfully occluded. After the procedure, the patients recovered and were discharged shortly.

RAP is a rare, but potentially life-threatening complication after PRB and can be treated successfully with superselective arterial embolization.