title: Metachronous renal vein and artery injure after percutaneous nephrostolithotomy.
abstract: BACKGROUND
  Percutaneous nephrostolithotomy is important approach for kidney stones removal. A percutaneous nephrostomy drainage tube placement is an effective method to stop venous bleeding. Occasionally, the catheter can pierce into the renal parenchyma, and migrate into the renal vein even to the vena cava.
  
  
  METHODS
  A 66-year-old woman underwent a percutaneous nephrostolithotomy for kidney staghorn stone complicating severe bleeding. A computed tomography angiography showed the percutaneous nephrostomy drainage tube inside the renal vein. The percutaneous nephrostomy drainage tube was withdrawn 3 cm back to the renal parenchyma/sinus/pelvis in stages with the surgical team on standby. Seven days later, the patient developed severe hematuria. Computed tomography angiography demonstrated the pseudoaneurysm located near the percutaneous nephrostomy drainage tube. Pseudoaneurysm is embolized successfully.
  
  
  CONCLUSIONS
  Our case shows intravenous misplacement of the nephrostomy tube and subsequent pseudoaneurysm after percutaneous nephrostolithotomy. To our knowledge, this seems to be the first documentation of major bleeding from the injury to both renal vein and artery. The percutaneous nephrostomy drainage tube can be withdrawn back to the renal parenchyma/sinus/pelvis in stages with the surgical team on standby, and the withdrawn distance may vary according to patient and catheter position.
authors.forename: Chaojun
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Urology, the First Affiliated Hospital, Medical of College, Zhejiang University, No, 79 Qing Chun road, Hangzhou 310003, China. chensw123@126.com.
authors.forename: Shanwen
authors.initials: S
authors.lastname: Chen
authors.forename: Fuqing
authors.initials: F
authors.lastname: Tang
authors.forename: Baihua
authors.initials: B
authors.lastname: Shen
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects*; D011859:Radiography; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D012082:Renal Veins / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D016896:Treatment Outcome