Renal artery pseudoaneurysm

Abstract The renal artery pseudoaneurysm embody a rare vascular complication coming of percutaneous procedures, renal biopsy, nephrectomy, penetrating traumas and more rarely blunt traumas. The clinical can be vary according the patient, the haematuria is the symptom more commom. Is necessary a high level of clinical suspicion for your diagnosis, this can be elucidated by through complementary exams as the eco-color Doppler and the computed tomography scan (CT). This report is a case of a patient submitted a right percutaneous renal biopsy and that, after the procedure started with macroscopic haematuria, urinary tenesmus and hypogastric pain. The diagnosis of pseudoaneurysm was given after one week of evolution when the patient was hospitalized because gross haematuria, tachycardia, hypotension and hypochondrium pain. In the angiotomography revealed a focal dilation of the accessory right renal inferior polar artery, dilation of renal pelvis and all the ureteral course with presence hyperdenso material (clots) inside the middle third of the ureter. The treatment for the majority of this cases are conservative, through arterial embolization, indicated for thouse of smaller dimensions in patients who are hemodynamically stable. However, it was decided by clinical treatment with aminocaproic acid 1 g, according to previous studies for therapy of haematuria. The patient received discharge without evidence of macroscopic haematuria and with normal renal ultrasound, following ambulatory care.

摘要：肾动脉假性动脉瘤（renal artery pseudoaneurysm）是一类罕见的血管并发症，多继发于经皮操作、肾活检、肾切除术、穿透性创伤，少数情况下可由钝性创伤引发。其临床表现存在显著个体差异，其中血尿为最常见的症状。临床诊断需具备高度怀疑意识，可通过彩色多普勒超声、计算机断层扫描（computed tomography scan，CT）等辅助检查明确。
本报告病例为一名接受右侧经皮肾活检的患者，术后出现肉眼血尿、尿意窘迫及下腹部疼痛。术后1周，患者因肉眼血尿、心动过速、低血压及季肋区疼痛再次入院，最终确诊为假性动脉瘤。血管CT造影显示，患者右肾下极副动脉存在局限性扩张，肾盂及全程输尿管扩张，输尿管中下段可见高密度血凝块。
此类病例的主流治疗方案多为保守治疗，对于血流动力学稳定且病灶尺寸较小的患者，可采用动脉栓塞术。但本病例结合既往血尿治疗相关研究，选择予以1g氨基己酸（aminocaproic acid）进行保守治疗。患者出院时无肉眼血尿表现，肾脏超声检查结果正常，后续接受门诊随访。