AB108. Renal arterial pseudoaneurysm and renal arteriovenous fistula following partial nephrectomy

Objective: To explore the optimal methods of diagnosis and treatment for renal arterial pseudoaneurysm (RAP) and renal arteriovenous fistula (RAVF) following partial nephrectomy.

Methods: A retrospective review was performed of patients undergoing partial nephrectomy in our department. The occurrence time, clinical manifestations, image features as well as treatment methods were analyzed and the relationship between RAP/RAVF and surgical methods, R.E.N.A.L score was investigated.

Results: Eleven were diagnosed with RAP/RAVF, with 8 after laparoscopic partial nephrectomy (LPN) and 3 following open partial nephrectomy (OPN). The incidence of RAP/RAVF after LPN showed no significant difference with that after OPN (P>0.05). The mean (range) R.E.N.A.L score was 6.6 [4-10], with low R.E.N.A.L score accounting for 6/11, median/high score accounting for 5/11. The major clinical manifestations included hematuria, hemorrhagic shock and the median occurrence time was 8 days after operation (1-120 days). Six patients took ultrasound examination with perinephric mass in 5 patients. In four patients undergoing enhanced computed tomography (CT), 2 patients were diagnosed with RAP. Renal angiography and super-selective arterial embolization were performed in all patients. All the 11 patients were cured after super-selective arterial embolization and the serum creatinine level before and after angioembolization showed no significant difference.

Conclusions: RAP/RAVF is relatively rare, which might have no relationship with surgical procedure or R.E.N.A.L score. Hematuria and hemorrhagic shock are the most common clinical manifestations. Ultrasound and CT might contribute to making diagnosis. Renal angiography and super-selective arterial embolization are the preferred method for diagnosis and treatment for RAP/RAVF.

Keywords: Partial nephrectomy; renal arterial pseudoaneurysm; renal arteriovenous fistula; super-selective arterial embolization