A 10-year review of blunt renal artery injuries at an urban level I trauma centre.
BACKGROUND
Little consensus exists over the management of high-grade renal injuries, with continued debate over observation versus invasive surgery. Blunt renal artery injury (BRAI) is a high-grade injury that may result in renal dysfunction, hypertension, or failure.


METHODS
Management of BRAI at a level I trauma centre during a decade was retrospectively reviewed to determine incidence, assess management strategy, and evaluate hospital outcomes. Data collected included demographics, injury details, standardised scoring, renal injury grade, haemodynamic stability, diagnostic modalities, medical interventions, mortality, and hospitalisation length.


RESULTS
Thirty-eight BRAI patients (21 Grade IV and 17 Grade V injuries) were admitted, representing 0.16% of trauma admissions, and consisting primarily of young males. Ultrasonography and CT was performed in 92.1% and 76.3% of patients, respectively. Primary management included exploratory laparotomy in 42.9%, angiography and embolisation in 34.3%, and observation in 22.9%. Six nephrectomies and one revascularisation were performed. The incidence of BRAI and use of angiography are higher than those reported in previous studies.


CONCLUSIONS
Over the past decade, increased use of CT as a diagnostic tool for confirming renal injury in haemodynamically stable patients at our institution may have contributed to the increase in BRAI detection. Higher utilisation of angiography has enabled a more conservative approach. In this series, angiography had a success rate of 94.4%. Angiography and embolisation or observation with careful monitoring are viable management options in haemodynamically stable patients with isolated BRAI.
Chow
Stuart J D
SJ
Grant Medical Center, Columbus, Ohio, 111 South Grant, Columbus, OH 43215, USA. schow@ohiohealth.com
Thompson
Keith J
KJ
Hartman
Jodi F
JF
Wright
Michelle L
ML
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011859:Radiography; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D012189:Retrospective Studies; D014193:Trauma Centers; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D055815:Young Adult