Journal of Trauma and Critical Care


Traumatic bidirectional renal artery thrombosis

Ruby Skinner

We present a case of acute blunt traumatic bilateral renal artery thrombosis in the setting of multisystem trauma. Catheterdirected thrombolysis with tissue plasminogen activator afforded kidney salvage with return of glomerular filtration rate to normal values at the time of patient discharge. With the advent of advances in endovascular techniques and interventional radiology, the treating physician has added very useful and relatively less invasive methods of managing otherwise complex traumatic injuries compared to open surgical techniques. One such application is in the treatment of acute traumatic solid organ injuries, and some of the earliest applications related to the management of blunt spleen and liver injuries. Acute traumatic renal artery occlusion is a rare pattern of kidney injury. Methods of treatment for kidney salvage described in the past included observation, open surgical revascularization, and endovascular techniques of revascularization. Catheter-directed thrombolysis for acute renal artery thrombosis has also been described including endovascular renal artery stent placement combined with catheter-directed thrombolysis. Success rates and kidney salvage rates vary considerably and may be related to the sparse data available with such a rare injury pattern.