Pediatric penetrating renal artery trauma: stent-graft treatment with 2-year follow-up.
OBJECTIVE
To report the 2-year follow-up of a pediatric patient who underwent stent-graft repair for penetrating renal artery trauma.


METHODS
An 11-year-old boy presented with a single anterior abdominal stab wound. He was normotensive (110/70 mmHg) but tachycardic (120 bpm). A focused abdominal sonogram for trauma revealed significant free intraperitoneal fluid. He underwent an urgent laparotomy, during which a minor liver injury was repaired. A large, nonpulsatile, non-expanding, left-sided retroperitoneal hematoma was identified but not explored. The boy remained hemodynamically unstable, so diagnostic angiography was performed. A single left proximal renal artery perforation was found. The lesion was treated with a 6x17-mm balloon-expandable stent-graft. Completion angiography demonstrated an excellent proximal and distal seal, without evidence of extravasation. The patient's condition stabilized, and he recovered completely. Serial renal duplex scans up to 2 years have documented normal renal artery blood flow and no migration of the stent-graft; the kidneys are equal in size. The serum creatinine level remains normal.


CONCLUSIONS
In appropriately selected patients, transcatheter stent-graft placement is a promising new kidney salvage modality to treat renal artery injury in children. Serious concern remains regarding the placement of covered stents in the pediatric population, as the long-term durability and the adaptability of growing arteries to renal stents are not known.
Muhs
Bart E
BE
Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands.
de Rooy
Kim
K
Goossens
Michele H J
MH
Mali
William P
WP
Moll
Frans L
FL
Verhagen
Hence J M
HJ
D019917:Blood Vessel Prosthesis Implantation; D002648:Child; D006801:Humans; D007813:Laparotomy; D008297:Male; D011859:Radiography; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D015607:Stents; D016896:Treatment Outcome; D014463:Ultrasonography; D014951:Wounds, Stab / Q000000981:diagnostic imaging / Q000601:surgery*