Management of renal artery injuries from external trauma

We reviewed the records of 27 patients with main renal artery injury admitted to our hospitals from 1959 through June 1986. Before 1969, 7 patients were hospitalized of whom 4 had nonsurgical management with total loss of function of the affected kidney, 2 had immediate nephrectomy and 1 died before treatment. Despite the nonfunctioning kidney no hypertension developed in 3 of the 4 patients followed for an average of 72 months. After 1969 when immediate radiological assessment and surgical management of main renal artery injuries were instituted 20 patients were hospitalized. Of 4 patients treated nonoperatively loss of function of the affected kidney resulted and hypertension occurred in 1, necessitating delayed nephrectomy, after an average followup of 3.5 months. Immediate nephrectomy was performed in 10 patients and vascular repair in 3. In both survivors who underwent vascular repair followup at 24 and 36 months, respectively, showed no hypertension but loss of approximately half of the function of the affected kidney. The other 3 patients died before treatment. Aggressive management reduced markedly the time from injury to diagnosis from a median of 48 hours before 1969 to 5 hours after 1969 but only a small number of patients were suitable for vascular repair, and this procedure did not restore complete function to the kidney.