Renal pseudoaneurysm and arterial-pelvicalyceal fistula after partial nephrectomy managed with staged angioembolization: A case report

Delayed haemorrhage after partial nephrectomy is usually attributed to a single vascular lesion and controlled by transarterial embolization. A 62-year-old man developed massive haematuria one week after left partial nephrectomy. CT angiography showed a segmental renal pseudoaneurysm, which was embolised superselectively. Bleeding recurred within 24 hours; repeat angiography revealed a separate arterial-pelvicalyceal fistula, treated by a second embolization with durable haemostasis. Recurrence after apparently successful embolization may therefore reflect a second, unrecognised lesion rather than treatment failure. A low threshold for repeat angiography and staged, lesion-specific embolization can achieve definitive control while preserving renal parenchyma.