Traumatic intimal tear of the renal artery without thrombosis

After a skiing accident a 15-year-old boy contracted a 1 cm long intimal tear of the distal part of the main renal artery on the left side demonstrated angiographically. Radiorenography showed a curve compatible with partial obstruction from the injured kidney while the other side was normal. The operation was delayed for 5 days and renewed preoperative angiography showed the same picture as 4 days previously. At operation it was found that an approximately 1 cm long segment of the intima was completely detached from the arterial wall. The loose fragments were removed and the distal intimal ends secured to the vascular wall. The longitudinal arteriotomy was closed directly without vein patch. The postoperative course was uneventful and repeated post-operative radiorenograms have shown normal registrations from the left kidney. This case illustrates that an intimal tear may stay open for 5 days and that it can be successfully treated by simple removal of the loose fragments.