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Renal Artery Pseudoaneurysm Following Laparoscopic Partial Nephrectomy
Dinesh Singh, M.D.1, Moinzadeh Ali2, Tony Finelli, M.D.3, Inderbir Gill, M.D.4.
1Yale University School of Medicine, New Haven, CT, USA, 2SUNY - Syracuse, Syracuse, NY, USA, 3University of Toronto, Toronto, ON, Canada, 4Cleveland Clinic Foundation, Cleveland, OH, USA.
Background: As laparoscopic partial nephrectomy (LPN) becomes more widely accepted and applied, it is important for clinicians to be familiar with its potential complications. This is the first report of the presentation, evaluation, and treatment of renal artery pseudoaneurysm (RAP) following LPN.
Methods: From September 1999 to October 2004, 391 LPN have been performed at our institution. Data were retrospectively reviewed to identify the six patients who presented with delayed bleeding complications and found to have an RAP. Size of tumor, depth of tumor, repair of collecting system, method of renal parenchyma repair, use of adjunct hemostatic agents, warm ischemia time, operative time, platelet and coagulation test results, angiographic findings and intervention were recorded.
Results: The incidence of RAP was 6 of 391 LPN (1.5%). All patients underwent a transperitoneal right LPN. Four of the 6 patients with the RAP complication occurred in 2002 or before. Median tumor size was 3.6 cm, with 4 endophytic tumors approaching (2) or abutting (2) the pelvicalyceal system (PCS). All underwent suture repair of the PCS. No patient required a blood transfusion intraoperatively or during the post-operative hospital course. On average, 31% of the kidney was excised. All patients exhibited delayed symptoms at a mean of post-operative day 12. All patients presented with one or more of the following symptoms: flank pain, gross hematuria, dizziness/syncope, fever, bloody or Jackson-Pratt drainage. Each patient received blood transfusions prior to ultimately undergoing angiography with definitive diagnosis and successful treatment of RAP. The artery forming the pseudoaneurysm was most commonly a 3rd order branch (4) or a 4th order branch (2). No patient had subsequent bleeding following embolization.
Conclusions: Renal artery pseudoaneurysm is an uncommon complication (1.5%). An understanding of its typical clinical presentation will enable clinicians to rapidly identify and effectively treat this potentially life-threatening complication. We hope this uncommon complication of RAP will become even more rare or eliminated with our evolving technique of LPN.
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