Renal artery intimal flaps after blunt trauma: indications for nonoperative therapy

After sustaining blunt abdominal trauma, two patients were found to have intimal flaps in extrahilar renal arteries without thrombosis. These renal artery injuries were observed without surgical repair because of severe concomitant multiple organ trauma. Continued patency of the renal arteries was confirmed by sequential renal scans or arteriograms. To decrease the risk of morbidity and death after blunt renovascular trauma, a patent artery with an intimal flap may be observed. Mandatory urgent repair is reserved for patients with bilateral renal injuries or for patients with a solitary kidney. Should symptomatic renal infarction or hypertension develop, delayed renal artery repair or nephrectomy is indicated.