Segmental dearterialization in penetrating renal trauma

Area of Science:

• Urology
• Trauma Surgery
• Vascular Surgery

Background:

• Refractory renal hemorrhage post-trauma traditionally necessitates nephrectomy or partial nephrectomy.
• Renal artery branching patterns indicate end-arteries supplying distinct renal segments without collateral circulation.

Observation:

• Life-threatening renal hemorrhage typically originates from a single segmental artery, identifiable via renal angiography.
• Selective renal arteriography identified the bleeding source in 13 of 14 patients with penetrating trauma.

Findings:

• Segmental dearterialization successfully achieved hemostasis in 12 of 14 patients.
• One patient required nephrectomy, and another needed ligation of a second segmental artery.
• All patients survived, with normal renin levels and no hypertension during follow-up (9-24 months).

Implications:

• Segmental renal dearterialization is a simple, effective technique for managing refractory renal hemorrhage.
• This approach maximizes renal parenchyma preservation compared to nephrectomy.
• It offers a viable alternative for trauma patients with severe kidney bleeding.