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Visceral Artery Injuries during Nephrectomy: A Systematic Review of Published Cases
Marion Cano1,2, Anne Lejay1, Hervé Lang2
1Department of Vascular Surgery, Kidney Transplantation and Innovation, Strasbourg University Hospital, Strasbourg, France.
Introduction:
Visceral artery injuries during nephrectomy, such as superior mesenteric artery (SMA) and coeliac artery (CA) injuries, are rare but potentially lethal complications. This systematic review was performed with a focus on visceral artery injuries during nephrectomy in order to describe how to prevent and manage SMA or CA injuries.
Method:
A systematic literature review was performed in Medline and the Cochrane Library from inception to December 2025 to identify published case reports and case series of SMA or CA injuries during nephrectomy. MeSH terms used were: "mesenteric artery, superior" "coeliac artery", "intra-operative complications", and "iatrogenic disease". Outcomes of interest were initial operative indication, cause and type of injury, anatomic risk factors, timing of diagnosis, type of vascular repair, and patient outcome. Quality of the studies was assessed according to the CARE guidelines.
Results:
After duplicate removal, screening, and full text eligibility assessment, 16 publications of varying quality reporting 20 cases of SMA and or CA injury during nephrectomy were included. All injuries occurred during left nephrectomy. Injury involved the SMA in 16 cases (80%) and both the SMA and CA in four cases (20%). The dominant mechanism was anatomic misperception: the SMA or CA was mistaken for the left renal artery, facilitated by bulky lymphadenopathy, large tumour size (median 12 cm), and post-inflammatory adhesions. SMA and CA injury was recognised intra-operatively in 16 cases (80%), while delayed diagnosis (ranging 12 - 48 hours) occurred in four cases (20%) and was associated with worse outcomes. Revascularisation was performed in 18 cases (90%), mostly by primary end to end anastomosis of the injured artery. Three patients died (15%).
Conclusion:
Visceral artery injuries during nephrectomy carry a substantial mortality risk, especially when the diagnosis is delayed. Careful pre-operative computed tomography angiography analysis, prompt injury identification, and immediate vascular surgical support are central elements of prevention and management.
