J Korean Soc Radiol.  2018 Dec;79(6):332-336. 10.3348/jksr.2018.79.6.332.

Balloon Angioplasty in a Pediatric Renal Artery Occlusion

• Song H
• Jung HD
• Kim JE
• Lee SM
• Hong W
• Lee K

• KMID: 2427381
• DOI: http://doi.org/10.3348/jksr.2018.79.6.332

Abstract

Renal artery injury is a rare complication in blunt trauma, but can cause devascularization of the kidney, leading to renal failure. It requires early diagnosis and management. The treatment of renal artery injury still remains controversial, but recent studies have reported the successful treatment outcome with endovascular stent placement. Nevertheless, there is no standard treatment strategy in cases of pediatric patients. We report a case of a 16-year-old girl with right renal artery occlusion associated with a grade IV liver laceration. She was treated with only balloon angioplasty, and the kidney showed marked improvement of parenchymal perfusion with normalized renal function. Treatment with only balloon angioplasty can be a treatment option in pediatric patients with renal artery injury.

MeSH Terms

Abdominal Injuries
Adolescent
Angioplasty, Balloon*
Early Diagnosis
Female
Humans
Kidney
Lacerations
Liver
Perfusion
Renal Artery*
Renal Insufficiency
Stents
Treatment Outcome

Figure

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  Fig. 1 Balloon angioplasty in a pediatric renal artery occlusion. A. A 16-year-old female came to the emergency department after a traffic accident on motorcycle. On abdomen-pelvis CT, there is near total devascularization of the right kidney with right perirenal hematoma (*). B. On right renal artery angiography, there is abrupt occlusion at 2 cm apart from the ostium (left panel). On selective angiography done after careful cannulation of the occluded segment, some distal branches of the right renal artery is patent, especially lower pole (right panel). C. Balloon angioplasty was done at the occluded renal artery with 3 mm × 4 cm balloon catheter on nominal pressure for 3 minutes. D. On completion angiography, there is still remained partial filling defect, but distal flow is patent. The parenchymal perfusion of the kidney shows marked recovery. E. On follow-up color Doppler ultrasound after two days of the procedure, the right renal artery shows normal artery waveform pattern of the sharp systolic upstroke, continuous forward diastolic flow, and low resistance waveform. F. On two months follow-up renal angiography CT after the balloon angioplasty, the right kidney is atrophied compared to the left. However, the parenchymal perfusion of the right kidney is markedly improved.

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