title: [Management of intraparenchymal pseudoaneurysm after blunt renal trauma: Results from a series of 325 patients].
abstract: BACKGROUND
  The purpose was to describe the management of intraparenchymal pseudoaneurysm (PA) after blunt renal trauma in our center, and to review the cases published in the literature, in order to propose a management algorithm.
  
  
  METHODS
  We reviewed the files of 325 patients included in a prospective database, from July, 2004, to May, 2016. A systematic review of the published cases was done with the keywords "blunt renal trauma" and "pseudoaneurysm" in Pubmed (excluding arteriovenous fistulas, open renal traumas and extraparenchymal PA) allowing us to analyze 29 extra cases. Management of these patients in our center is decribed.
  
  
  RESULTS
  Among 325 kidney trauma patients, 160 (49.3%) had grade IV and V renal trauma. Conservative management was done in 93.2%. We noted 8 cases of PA, with an incidence of 2.5%. Four patients required angioembolization. Four patients were treated by watchful waiting, with 2 cases of spontaneous occlusion, one case of absence of regression and embolization, and one case of occult hemorrhage. All PA with a favorable outcome were less than 1cm. The mean relative renal scintigraphic function at 6 months of the kidneys requiring embolization was 71.6%. The literature review reported 29 published cases, among whom 26 required embolization, with a success rate of 84.6%. Two cases were just watched, but one was finally embolized in the absence of regression.
  
  
  CONCLUSIONS
  Pseudoneurysm formation after blunt renal trauma is a rare complication (2.5%). In case of clinical symptoms or hemodynamic instability, embolization allows a good renal preservation. Watchful waiting seems to be an option in asymptomatic cases with a PA less than 1cm.
  
  
  METHODS
  5.
authors.affiliation: Centre hospitalo-universitaire de Clermont-Ferrand, 58, rue Montalembert, BP 69, 63003 Clermont-Ferrand cedex 1, France. Electronic address: fasol@neuf.fr.
authors.forename: R
authors.initials: R
authors.lastname: Guyot
authors.affiliation: Centre hospitalier Annecy-Genevois, 1, avenue de l'Hôpital Metz-Tessy, BP 90074, 74374 Pringy cedex, France.
authors.forename: V
authors.initials: V
authors.lastname: Arnoux
authors.affiliation: Centre hospitalier universitaire Grenoble Alpes, CS 10217, 38043 Grenoble cedex 9, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Descotes
authors.affiliation: Centre hospitalier universitaire Grenoble Alpes, CS 10217, 38043 Grenoble cedex 9, France.
authors.forename: N
authors.initials: N
authors.lastname: Terrier
authors.affiliation: Centre hospitalier universitaire Grenoble Alpes, CS 10217, 38043 Grenoble cedex 9, France.
authors.forename: B
authors.initials: B
authors.lastname: Boillot
authors.affiliation: Centre hospitalier universitaire Grenoble Alpes, CS 10217, 38043 Grenoble cedex 9, France.
authors.forename: C
authors.initials: C
authors.lastname: Thuillier
authors.affiliation: Centre hospitalier universitaire Grenoble Alpes, CS 10217, 38043 Grenoble cedex 9, France.
authors.forename: J-J
authors.initials: JJ
authors.lastname: Rambeaud
authors.affiliation: Centre hospitalier universitaire Grenoble Alpes, CS 10217, 38043 Grenoble cedex 9, France.
authors.forename: J-A
authors.initials: JA
authors.lastname: Long
authors.affiliation: Centre hospitalier universitaire Grenoble Alpes, CS 10217, 38043 Grenoble cedex 9, France.
authors.forename: G
authors.initials: G
authors.lastname: Fiard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D002648:Child; D004621:Embolization, Therapeutic; D005260:Female; D006417:Hematuria / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007668:Kidney / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012075:Remission, Spontaneous; D012077:Renal Artery / Q000293:injuries*; D012082:Renal Veins / Q000293:injuries*; D012189:Retrospective Studies; D057832:Watchful Waiting; D014949:Wounds, Nonpenetrating / Q000150:complications*; D055815:Young Adult
keywords: Blunt renal trauma; Pseudoaneurysm; Pseudoanévrisme; Traumatisme rénal fermé