Traumatic renal artery occlusion: a review of the literature

To better define what constitutes appropriate treatment for traumatic renal artery occlusion, we analyzed our experience along with 147 other case reports from the literature. We recently reported our 15-year experience with 12 patients (13 injuries) who presented to our trauma centers with renal artery occlusion secondary to blunt trauma. This experience prompted a review of the literature. From this review, we identified an additional 19 cases of bilateral and 128 cases of unilateral renal artery occlusion that met our inclusion criteria. Of the 20 patients with bilateral renal artery occlusion, surgical revascularization was attempted in 16 and successful in 9 (56%). Of the 139 patients with unilateral renal artery occlusion, surgical revascularization was attempted in 34 and successful in 9 (26%). Evidence of decreased renal function was noted in 67% of those who had a successful revascularization for unilateral injury at a mean 1.8-year follow-up, whereas 12% experienced hypertension at a mean 3.1-year follow-up. Hypertension developed in 34 (32%) of the 105 patients who did not have revascularization attempted and was present by a mean 97 days postinjury. Surgical revascularization for unilateral renal artery occlusion seldom results in a successful outcome. Revascularization is indicated in patients with bilateral renal artery occlusion and in those with injury to a solitary kidney. Patients who are observed must be followed closely for development of hypertension.