[Traumatic dissection of the renal pedicle. Modalities of management in adults and children].
OBJECTIVE
To evaluate the medium-term results of treatment for traumatic dissection of the renal arteries in a series of 12 cases and to propose emergency management based on recent endovascular revascularization techniques.


METHODS
Between January 1999 and July 2003, 12 patients were admitted for closed trauma of the renal artery. There were 11 dissections with thrombosis and 1 intimal flap without distal thrombosis. Six patients were revascularized surgically (3 reno-renal bypass grafts, 3 auto-transplantations), 4 patients were treated by an endovascular procedure and 2 patients were treated conservatively with simple surveillance. Renal function, renal artery patency and blood pressure were evaluated immediately and at 3 months by clinical examination, Doppler ultrasound of the renal artery or CT angiography, and renal scintigraphy.


RESULTS
In the group of 6 patients undergoing surgical revascularization (mean warm ischaemia time: 8 hours 30 minutes), 2 nephrectomies were performed (1 failure of revascularization, 1 sepsis in a non-functioning kidney). The other 4 patients presented negligible renal function on scintigraphy at 3 months despite patent renal arteries. Among the 4 patients undergoing endovascular revascularization (mean warm ischaemia time: 8 hours 50 minutes), 2 died from associated lesions and 2 had a non-functioning kidney (1 stent thrombosis, 1 silent kidney despite a patent renal artery). No cases of hypertension were observed regardless of the type of management.


CONCLUSIONS
Renal revascularization after thrombosis due to traumatic dissection of the renal artery must not be performed systematically after a warm ischaemia time of more than 4 hours in view of the poor recovery of renal function and the absence of morbidity associated with simple surveillance. When a procedure is performed, evaluation of the results must be based on morphological as well as functional parameters (scintigraphy).
Long
Jean-Alexandre
JA
Service de Chirurgie Urologique et de la Transplantation, CHU de Grenoble, France.
Manel
Arnaud
A
Penillon
Sébastien
S
Badet
Lionel
L
Sessa
Carmine
C
Descotes
Jean-Luc
JL
Sengel
Christian
C
Rambeaud
Jean-Jacques
JJ
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000293:injuries* / Q000601:surgery*; D012189:Retrospective Studies
Dissection traumatique du pédicule rénal. Modalités de prise en charge chez l'adulte et l'enfant.