Epidemiology and management of isolated blunt renal artery injuries.

Abstract

BACKGROUND:

Isolated blunt renal artery injury (BRAI) is uncommon. Treatment options include observation, nephrectomy, surgical reconstruction and endovascular stenting. Over the last decade, there has been an increasing use of angiointervention techniques in vascular trauma. Previous studies reported underutilization of endovascular stenting in BRAI, in favor of observation. The aim of this study was to examine the epidemiology and assess changes in the management of isolated BRAI over the last decade.

METHODS:

Patients with BRAI identified from the National Trauma Data Bank (2016-2017). Deaths in the emergency department, transferral from outside hospital, and those with associated high-grade kidney injuries were excluded. Demographics, type of renal artery injury, and renal artery management were analyzed. Multivariate analysis was used to identify independent factors associated with isolated BRAI.

RESULTS:

During the study period, there were 1,708,076 patients with blunt trauma and 873 (0.05%) of them had BRAI. After exclusions, 563 patients with isolated BRAI who met the criteria for inclusion in the analysis. Auto versus pedestrian mechanism and male sex were associated with the highest risk for isolated BRAI. Comorbidities, such as hypertension or diabetes, were not associated with an increased risk of BRAI. Seatbelt use had a protective effect against BRAI. In the majority of patients (534, 95%), the renal artery injury was treated with observation, 23 (4%) with nephrectomy, 5 (0.9%) with endovascular stent and 1 (0.2%) with open renal artery repair. Among the 103 patients with isolated major renal artery laceration, 91.2% were treated with observation, 7.8% with nephrectomy and 1% with stenting.

CONCLUSION:

Isolated blunt renal artery trauma is rare. The vast majority of patients with BRAI is managed with observation with only a small number undergoing endovascular intervention. Endovascular stenting utilization has remained very low and has not changed in the last decade.

• Authors: Natthida Owattanapanich, Elizabeth Benjamin, Meghan Lewis, Jie Cai, Demetrios Demetriades
• Journal: The journal of trauma and acute care surgery (J Trauma Acute Care Surg) Vol. 90 Issue 6 Pg. 1003-1008 (06 01 2021) ISSN: 2163-0763 [Electronic] United States
• PMID: 34016924 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Topics

• Abdominal Injuries (diagnosis, epidemiology, therapy)
• Adult
• Conservative Treatment (statistics & numerical data, trends)
• Endovascular Procedures (statistics & numerical data, trends)
• Female
• Humans
• Incidence
• Injury Severity Score
• Male
• Middle Aged
• Renal Artery (injuries, surgery)
• Retrospective Studies
• Risk Factors
• Treatment Outcome
• Wounds, Nonpenetrating (diagnosis, epidemiology, therapy)
• Young Adult