Traumatic renal artery dissection: from imaging to management.

Area of Science:

• Radiology
• Trauma Surgery
• Vascular Surgery

Background:

• Blunt trauma can cause renal artery injury, increasingly diagnosed with multidetector computed tomography (CT).
• Optimal treatment for traumatic renal artery dissection remains controversial due to a lack of established guidelines.
• Understanding the pathophysiology of ischemic kidney damage is crucial for therapeutic decision-making.

Purpose of the Study:

• To review imaging findings of traumatic renal artery dissection.
• To elucidate the physiopathology of ischemic kidney damage.
• To guide the selection of optimal therapeutic strategies: conservative, endovascular, or surgical.

Main Methods:

• Review of imaging findings in patients with traumatic renal artery dissection.
• Classification of five main patterns of traumatic renal artery dissection.
• Analysis of management strategies based on patient factors and injury characteristics.

Main Results:

• Five patterns identified: avulsion, segmental dissection, preocclusive dissection, stenosis without flow limitation, and intimal tear.
• Management in polytrauma patients depends on hemodynamic status, associated lesions, and diagnosis time.
• Non-operative management is preferred for non-flow-limiting dissections; angioembolization aids active bleeding control.

Conclusions:

• Management of traumatic renal artery dissection is multifactorial, prioritizing patient stability and injury pattern.
• Endovascular techniques like embolization and stenting have specific indications based on flow limitation and timing.
• Antiplatelet therapy is recommended post-stenting, balanced against bleeding risk.