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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Endovascular treatment of traumatic renal artery pseudoaneurysm with a Stanford type A intramural haematoma: A case report
Yook Kim, Jin Young Lee, Jin Suk Lee, Jin-Bong Ye, Se Heon Kim, Young Hoon Sul, Su Young Yoon, Jung Hee Choi, Hanlim Choi
Yook Kim, Department of Radiology, Chungbuk National University Hospital, Cheongju-si 28644, Chungcheongbuk-do, South Korea
Jin Young Lee, Jin Suk Lee, Jin-Bong Ye, Se Heon Kim, Department of Trauma Surgery, Chungbuk National University Hospital, Cheongju-si 28644, Chungcheongbuk-do, South Korea
Young Hoon Sul, Department of Trauma Surgery, College of Medicine, Chungbuk National University, Cheongju-si 28644, Chungcheongbuk-do, South Korea
Su Young Yoon, Cardiovascular and Thoracic Surgery, Chungbuk National University Hospital, Cheongju-si 28644, Chungcheongbuk-do, South Korea
Jung Hee Choi, Anesthesiology and Pain Medicine, Chungbuk National University Hospital, Cheongju-si 28644, Chungcheongbuk-do, South Korea
Hanlim Choi, Department of Surgery, Chungbuk National University Hospital, Cheongju-si 28644, Chungcheongbuk-do, South Korea
Author contributions: Lee JY and Kim Y contributed to manuscript drafting and reviewed the literature; Kim Y, Lee JS, Ye JB, Kim SH, Sul YH, Yoon SY, Choi JH, and Choi H collected clinical data and participated in treatment; all authors read and approved the final manuscript.
Informed consent statement: The institutional review board of Chungbuk National University Hospital approved a retrospective review of the medical records (2020-12-007) and waived the requirement to obtain informed consent from the patient.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jin Young Lee, Doctor, Surgeon, Department of Trauma Surgery, Chungbuk National University Hospital, 776 1Sunhwan-ro, Seowon-gu, Cheongju-si 28644, Chungcheongbuk-do, South Korea. client80@hanmail.net
Received: May 4, 2022
Peer-review started: May 4, 2022
First decision: June 16, 2022
Revised: June 28, 2022
Accepted: August 21, 2022
Article in press: August 21, 2022
Published online: September 26, 2022
BACKGROUND
Aortic intramural hematoma (IMH) associated with aortic branch tear and intramurally located pseudoaneurysm after blunt trauma has not been reported. Here, we report a case of progressive type A aortic IMH associated with a pseudoaneurysm arising from the injured proximal renal artery after blunt trauma.
CASE SUMMARY
During logging operations, a 66-year-old man experienced blunt force trauma after being injured by a fallen tree. He arrived at our trauma center with a left flank pain complaint. Computed tomography (CT) revealed a pseudoaneurysm arising from the proximal renal artery (localized within the aortic media) and Stanford type A IMH. A covered stent was deployed along the left main renal artery, bridging the pseudoaneurysm and covering the parent artery, successfully excluding the pseudoaneurysm as confirmed using aortography. However, although the degree of the pseudoaneurysm decreased, follow-up CT revealed remnant pseudoaneurysm, likely caused by an endoleak. Subsequently, a covered stent was additionally installed through the previously deployed covered stent. Successful exclusion of the pseudoaneurysm was confirmed using final aortography. In the 7-mo follow-up CT scan, the IMH and pseudoaneurysm completely disappeared with no evidence of stent-related complications.
CONCLUSION
Endovascular treatment such as stent-graft placement can be an effective and safe treatment for traumatic renal artery injury.
Core Tip: We report the case of an adult male who presented with left flank pain after experiencing blunt trauma from being injured by a fallen tree. Investigations revealed a pseudoaneurysm arising from the proximal renal artery and Stanford type A IMH. The patient received endovascular treatment, and the successful exclusion of the pseudoaneurysm was confirmed using final aortography. A postoperative computed tomography scan showed the complete disappearance of the intramural hematoma and pseudoaneurysm with no stent-related complications. Consequently, we propose that endovascular treatment such as stent-graft placement can be an effective and safe treatment for traumatic renal artery injury.
