Segmental dearterialization in penetrating renal trauma

Refractory renal haemorrhage following low velocity penetrating trauma has conventionally been treated by nephrectomy or partial nephrectomy. Anatomical studies have demonstrated that the renal artery branches are end-arteries, each branch supplying a renal segment, with no collateral artery supply between segments. Life-threatening haemorrhage is arterial, and usually issues from a single segmental artery easily demonstrable by renal angiography. Fourteen patients had various segmental arteries ligated to control haemorrhage. Associated visceral injuries were present in 4 patients. Preoperative selective renal arteriography was possible in 13 patients and demonstrated the bleeding site in all cases. Segmental dearterialization produced haemostasis in 12 of the 14 patients. One patient required nephrectomy and one patient ligation of a second segmental artery to control bleeding. All the patients survived the operative procedure. Supine renin levels were normal on the fourteenth postoperative day and no patient developed hypertension during the follow-up period of 9-24 months. Segmental renal dearterialization by open operation is a simple and effective technique of controlling refractory renal haemorrhage with maximum preservation of renal parenchyma.