Revascularization of traumatic thrombosis of the renal artery

Renal artery thrombosis, although well recognized, remains a rare complication of blunt abdominal trauma. In an effort to resolve the current controversy concerning the appropriate therapy, we have reviewed the available literature. Only those instances when the injury was due to blunt trauma and resulted in complete occlusion of the renal artery, documented by roentgenographic means, were included in this review. Avulsion injuries, incomplete occlusion or branch artery injuries were also excluded. In order to be classified as a surgical success, postoperative documentation of renal function and a patent renal artery were required. Only nine successfully performed vascularization procedures were identified. There were four instances of bilateral obstruction with postoperative serum creatinine levels ranging from 1.77 to 7.1 milligrams per deciliter. All required postoperative dialysis ranging from three days to three months in duration. Thirty-five patients with an unilaterally obstructed renal artery underwent attempted revascularization. Five patients, all with a presumed ischemic time of less than 12 hours, had a successful outcome. Postoperatively, four patients demonstrated either a decrease in size or function of the injured kidney. Thirteen eventually required nephrectomy.