Renal Artery Pseudoaneurysm Following Laparoscopic Partial Nephrectomy

Edan Y. Shapiro, A. Ari Hakimi, Elias S. Hyams, Jacob Cynamon, Michael Stifelman, Reza Ghavamian

Research output: Contribution to journalArticle

38 Scopus citations

Abstract

Objectives: To present our experience with the management of renal artery pseudoaneurysms following laparoscopic partial nephrectomy (LPN). Methods: Our bi-institutional LPN database of 259 patients from July 2001 to April 2008 was queried for patients diagnosed with a postoperative renal artery pseudoaneurysm. Demographic data, perioperative course, complications, and follow-up studies in identified subjects were analyzed. Postembolization success was defined as symptomatic relief, resolution of hematuria, and a stable hematocrit and serum creatinine. Results: We identified 6 patients (2.3%) who were diagnosed with a renal artery pseudoaneurysm after LPN. The mean age of our cohort was 61.2 years (49-76), mean operative time was 208 minutes (140-265), and mean estimated blood loss was 408 mL (50-800). Patients presented at a mean of 12.6 days (5-23) after the initial surgery. Five patients had gross hematuria and a decreased hematocrit, with 1 patient presenting with clinical symptoms of hypovolemia. The sixth patient was incidentally diagnosed. The diagnosis of a renal artery pseudoaneurysm was confirmed in all cases by angiography. Selective angioembolization was successfully performed in all patients. At a median follow-up of 8.3 months all patients (100%) remained without any evidence of recurrence. Conclusions: Although pseudoaneuryms are a rare postoperative complication of LPN, they are potentially life-threatening. Early identification and proper management can help reduce the potential morbidity associated with pseudoaneurysms. Our experience demonstrates the feasibility and supports the use of selective angioembolization as an excellent first-line option for patients who present with this form of delayed bleeding.

Original languageEnglish (US)
Pages (from-to)819-823
Number of pages5
JournalUrology
Volume74
Issue number4
DOIs
StatePublished - Oct 1 2009

ASJC Scopus subject areas

  • Urology

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    Shapiro, E. Y., Ari Hakimi, A., Hyams, E. S., Cynamon, J., Stifelman, M., & Ghavamian, R. (2009). Renal Artery Pseudoaneurysm Following Laparoscopic Partial Nephrectomy. Urology, 74(4), 819-823. https://doi.org/10.1016/j.urology.2009.03.056