Renal Arterial Injuries

A Single Center Analysis of Management Strategies and Outcomes

Sean P. Elliott, Ephrem Olweny, Jack W. McAninch

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Purpose: Management of main and segmental renal artery injury following external trauma is controversial. After main renal artery injury the controversy surrounds nephrectomy vs revascularization, whereas after segmental renal artery injury the debate involves operative vs nonoperative management. We reviewed our experience with renal artery injury management at a single trauma center with the goal of identifying optimal clinical management strategies. Materials and Methods: Data on a total of 82 renal artery injuries in 81 patients collected between 1978 and 2006 were retrospectively reviewed. Patient demographics, length of stay, transfusion requirements and injury characteristics (artery subtype, grade, mechanism, and associated parenchymal, venous and nonrenal injuries) were recorded. Management strategies and outcomes for each renal artery injury subtype were compared. Results: Median patient age was 28 years (range 4 to 74) and 90% of the patients were male. Main renal artery injury occurred in 36 of 81 patients (43%) and segmental renal artery injury occurred in 45 (57%). Injury characteristics were similar for each renal artery injury subtype. For main renal artery injury the respective outcomes of nephrectomy vs vascular repair were a mean transfusion of 10,275 vs 6,125 ml (p = 0.39), length of stay 18 days for each, mortality rate 26% vs 13%, renal failure rate 8% vs 25% and renal insufficiency/impaired selective function by renal scintigraphy 4% vs 13% (each p not significant). For segmental renal artery injury operative vs nonoperative management was associated with a mean transfusion of 4,994 vs 820 ml (p = 0.01), length of stay 29 vs 11 days (p = 0.23) and mortality rate 8% vs 6% (p = 1.0). Renal failure and impaired selective renal function on scintigraphy were similar between the groups. Conclusions: Nephrectomy for main renal artery injury has outcomes similar to those of vascular repair and it does not worsen posttreatment renal function in the short term. Nonoperative management for segmental renal artery injury results in excellent outcomes.

Original languageEnglish (US)
Pages (from-to)2451-2455
Number of pages5
JournalJournal of Urology
Volume178
Issue number6
DOIs
StatePublished - Dec 1 2007
Externally publishedYes

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Renal Artery
Kidney
Wounds and Injuries
Nephrectomy
Renal Insufficiency
Length of Stay
Radionuclide Imaging
Blood Vessels
Mortality
Trauma Centers
Arteries
Demography

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Elliott, Sean P. ; Olweny, Ephrem ; McAninch, Jack W. / Renal Arterial Injuries : A Single Center Analysis of Management Strategies and Outcomes. In: Journal of Urology. 2007 ; Vol. 178, No. 6. pp. 2451-2455.
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abstract = "Purpose: Management of main and segmental renal artery injury following external trauma is controversial. After main renal artery injury the controversy surrounds nephrectomy vs revascularization, whereas after segmental renal artery injury the debate involves operative vs nonoperative management. We reviewed our experience with renal artery injury management at a single trauma center with the goal of identifying optimal clinical management strategies. Materials and Methods: Data on a total of 82 renal artery injuries in 81 patients collected between 1978 and 2006 were retrospectively reviewed. Patient demographics, length of stay, transfusion requirements and injury characteristics (artery subtype, grade, mechanism, and associated parenchymal, venous and nonrenal injuries) were recorded. Management strategies and outcomes for each renal artery injury subtype were compared. Results: Median patient age was 28 years (range 4 to 74) and 90{\%} of the patients were male. Main renal artery injury occurred in 36 of 81 patients (43{\%}) and segmental renal artery injury occurred in 45 (57{\%}). Injury characteristics were similar for each renal artery injury subtype. For main renal artery injury the respective outcomes of nephrectomy vs vascular repair were a mean transfusion of 10,275 vs 6,125 ml (p = 0.39), length of stay 18 days for each, mortality rate 26{\%} vs 13{\%}, renal failure rate 8{\%} vs 25{\%} and renal insufficiency/impaired selective function by renal scintigraphy 4{\%} vs 13{\%} (each p not significant). For segmental renal artery injury operative vs nonoperative management was associated with a mean transfusion of 4,994 vs 820 ml (p = 0.01), length of stay 29 vs 11 days (p = 0.23) and mortality rate 8{\%} vs 6{\%} (p = 1.0). Renal failure and impaired selective renal function on scintigraphy were similar between the groups. Conclusions: Nephrectomy for main renal artery injury has outcomes similar to those of vascular repair and it does not worsen posttreatment renal function in the short term. Nonoperative management for segmental renal artery injury results in excellent outcomes.",
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Renal Arterial Injuries : A Single Center Analysis of Management Strategies and Outcomes. / Elliott, Sean P.; Olweny, Ephrem; McAninch, Jack W.

In: Journal of Urology, Vol. 178, No. 6, 01.12.2007, p. 2451-2455.

Research output: Contribution to journalArticle

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N2 - Purpose: Management of main and segmental renal artery injury following external trauma is controversial. After main renal artery injury the controversy surrounds nephrectomy vs revascularization, whereas after segmental renal artery injury the debate involves operative vs nonoperative management. We reviewed our experience with renal artery injury management at a single trauma center with the goal of identifying optimal clinical management strategies. Materials and Methods: Data on a total of 82 renal artery injuries in 81 patients collected between 1978 and 2006 were retrospectively reviewed. Patient demographics, length of stay, transfusion requirements and injury characteristics (artery subtype, grade, mechanism, and associated parenchymal, venous and nonrenal injuries) were recorded. Management strategies and outcomes for each renal artery injury subtype were compared. Results: Median patient age was 28 years (range 4 to 74) and 90% of the patients were male. Main renal artery injury occurred in 36 of 81 patients (43%) and segmental renal artery injury occurred in 45 (57%). Injury characteristics were similar for each renal artery injury subtype. For main renal artery injury the respective outcomes of nephrectomy vs vascular repair were a mean transfusion of 10,275 vs 6,125 ml (p = 0.39), length of stay 18 days for each, mortality rate 26% vs 13%, renal failure rate 8% vs 25% and renal insufficiency/impaired selective function by renal scintigraphy 4% vs 13% (each p not significant). For segmental renal artery injury operative vs nonoperative management was associated with a mean transfusion of 4,994 vs 820 ml (p = 0.01), length of stay 29 vs 11 days (p = 0.23) and mortality rate 8% vs 6% (p = 1.0). Renal failure and impaired selective renal function on scintigraphy were similar between the groups. Conclusions: Nephrectomy for main renal artery injury has outcomes similar to those of vascular repair and it does not worsen posttreatment renal function in the short term. Nonoperative management for segmental renal artery injury results in excellent outcomes.

AB - Purpose: Management of main and segmental renal artery injury following external trauma is controversial. After main renal artery injury the controversy surrounds nephrectomy vs revascularization, whereas after segmental renal artery injury the debate involves operative vs nonoperative management. We reviewed our experience with renal artery injury management at a single trauma center with the goal of identifying optimal clinical management strategies. Materials and Methods: Data on a total of 82 renal artery injuries in 81 patients collected between 1978 and 2006 were retrospectively reviewed. Patient demographics, length of stay, transfusion requirements and injury characteristics (artery subtype, grade, mechanism, and associated parenchymal, venous and nonrenal injuries) were recorded. Management strategies and outcomes for each renal artery injury subtype were compared. Results: Median patient age was 28 years (range 4 to 74) and 90% of the patients were male. Main renal artery injury occurred in 36 of 81 patients (43%) and segmental renal artery injury occurred in 45 (57%). Injury characteristics were similar for each renal artery injury subtype. For main renal artery injury the respective outcomes of nephrectomy vs vascular repair were a mean transfusion of 10,275 vs 6,125 ml (p = 0.39), length of stay 18 days for each, mortality rate 26% vs 13%, renal failure rate 8% vs 25% and renal insufficiency/impaired selective function by renal scintigraphy 4% vs 13% (each p not significant). For segmental renal artery injury operative vs nonoperative management was associated with a mean transfusion of 4,994 vs 820 ml (p = 0.01), length of stay 29 vs 11 days (p = 0.23) and mortality rate 8% vs 6% (p = 1.0). Renal failure and impaired selective renal function on scintigraphy were similar between the groups. Conclusions: Nephrectomy for main renal artery injury has outcomes similar to those of vascular repair and it does not worsen posttreatment renal function in the short term. Nonoperative management for segmental renal artery injury results in excellent outcomes.

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