Abstract
Purpose
To determine the incidence, injury type, injury associations, and management of patients with renal vein injuries following trauma.
Methods
This is a 10-year single-center retrospective observational study of patients with renal vein injuries identified on admission abdominopelvic CT following trauma. Our institutional trauma registry and radiology information system (RIS) was used to identify patients with renal vein injuries. The medical records and imaging exams were reviewed to determine venous injury type, associated injuries, management, and outcomes.
Results
Fifteen (15) patients with renal vein injuries (N = 9 right side) were identified out of 36,077 trauma evaluations, for an overall incidence of 0.042%. Eight (53.3%) were male with a mean age of 36.3 years (range 9–67 years) and a mean Injury Severity Score (ISS) of 32 (range 13–57). The most common imaging findings were pseudoaneurysm formation with or without intimal injury and intraluminal thrombus seen in 86.7% of the cohort. Twelve patients (80.0%) had other acute traumatic renal findings, most commonly an ipsilateral grade 4 or higher renal injury. Angiography was performed in 6 patients (40.0%), however no patients received renal vein specific endovascular evaluation, endovascular treatment, or surgical treatment of their renal vein injuries. Three patients were treated with long-term anticoagulation, of which one received an IVC filter. There were no known renal vein injury specific mortalities.
Conclusions
Renal vein injuries are an extremely rare entity but can be detected on admission CT. The most common injury patterns include an intimal injury with intraluminal thrombus and pseudoaneurysm in combination with an intimal injury and intraluminal thrombus. Conservative, nonoperative management was successfully employed in all cases with no renal vein specific mortalities.
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References
Alonso RC, Nacenta SB, Martinez PD, Guerrero AS, Fuentes CG (2009) Kidney in danger: CT findings of blunt and penetrating renal trauma. RadioGraphics 74(3):2033–2054
Park SJ, Kim JK, Kim KE, Cho KS (2006) MDCT findings of renal trauma. AJR Am J Roentgenol 187:541–547
Sturm JT, Perry JF, Cass AS (1975) Renal artery and vein injury following blunt trauma. Ann Surg 182(6):696–698
Tillou A, Romero J, Asensio JA, Best CD, Petrone P, Roldan G, Rojo E (2001) Renal vascular injuries. Surg Clin N Am 81(6):1417–1430
Holly BP, Steenburg SD (2011) Multidetector CT of blunt traumatic venous injuries in the chest, abdomen, and pelvis. Radiographics 31(5):1415–1424
Baghdanian AH, Armetta AS, Baghdanian AA, LeBedis CA, Anderson SW, Soto JA (2016) CT of major vascular injury in blunt abdominopelvic trauma. RadioGraphics 36(3):872–890
Maruhashi T, Kashimi F, Yamaya T, Takeuchi I, Kataoka Y, Asari Y (2017) A case of renal vein branch injury identified by multidetector computed tomography. Trauma Case Rep 7:19–22
Monroe EJ, Kogut MJ, Ingraham CR (2015) Traumatic renal vein pseudoaneurysm. J Vasc Surg Cases 1:157–160
Samuelson AL, Koyle MA, Strain JD (2007) Repair of right renal vein avulsion after auto-pedestrian crash. J Trauma Acute Care Surg 63:432–434
Wright JL, Nathens AB, Rivara FP, Wessells H (2006) Renal and extrarenal predictors of nephrectomy from the national trauma data bank. J Urol 175(3):970–975
Petrone P, Perez-Calvo J, Brathwaire CEM, Islam S, Joseph DK (2019) Traumatic kidney injuries: a systematic review and meta-analysis. Int J Surg 74:13–21
Berkovich GY, Ramchandani P, Preate DL, Rovner ES, Shaprio MB, Banner MP (2001) Renal vein thrombosis after martial arts trauma. J Trauma 50:144–146
Blankenship B, Earls JP, Talner LB (1997) Renal vein thrombosis after vascular pedicle injury. AJR Am J Roentgenol 168(6):1574
Fanney DR, Casillas J, Murphy BJ (1990) CT in the diagnosis of renal trauma. RadioGraphics 10:29–40
Meija JC, Myers JG, Stewart RM, Dent DL, Connaughton JC (2006) A right renal vein pseudoaneurysm secondary to blunt abdominal trauma: a case report and review of the literature. J Trauma 60(5):1124–1128
Sclafani SJ, Goldstein AS, Panetta T, Phillips TF, Golueke P, Gordon DH, Glanz S (1985) CT diagnosis of renal pedicle injury. Urol Radiol 7(2):63–68
Moore EE, Shackford SR, Pachter HL, McAninch JW, Brownder BD, Champion HR, Flint LM, Gennarelli TA, Malangoni MA, Ramenofsky ML, Trafton PG (1989) Organ injury scaling: spleen, liver, kidney. J Trauma 29(12):1664–1666
Kozar RA, Crandall M, Shanmuganathan K, Zarzaur BL, Coburn M, Cribari C, Kaups K, Schuster K, Tominaga GT (2018) Organ injury scaling 2018 update: spleen, liver, and kidney. J Trauma Acute Care Surg 85(6):1119–1122
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SDS—research grant support from the Department of the Army but unrelated to the work contained in this manuscript. The other authors declare no conflict of interest.
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Hart, K., Johnson, G. & Steenburg, S.D. Renal vein injuries: a 10-year, single institution experience with a rare injury following blunt abdominal trauma. Emerg Radiol 28, 533–539 (2021). https://doi.org/10.1007/s10140-020-01878-y
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DOI: https://doi.org/10.1007/s10140-020-01878-y