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  • Review Article
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Renal pseudoaneurysm: an overview

Nature Reviews Urology volume 7, pages 619–625 (2010)Cite this article

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Abstract

Renal pseudoaneurysm is a rare vascular lesion that arises when an arterial injury within the kidney leads to contained hemorrhage. The associated hematoma forms outside the arterial wall and is typically surrounded by a layer of fibrous inflammatory tissue and blood clot. These lesions are unstable and their rupture can lead to life-threatening hemorrhage. Renal pseudoaneurysm has been reported to occur in various clinical scenarios, including after renal trauma, surgery and percutaneous procedures, as well as inflammatory and neoplastic processes within the kidney. Endovascular selective angioembolization is the mainstay of treatment, although surgery might be indicated when hemostasis and repair of the arterial wall defect are required. Percutaneous ultrasound-guided embolization is an additional option for patients with unfavorable vascular anatomy, or who cannot tolerate or have contraindications to the use of intravenous contrast agents. Some evidence suggests that these lesions can regress without intervention, although observation alone is not recommended as a management strategy in the vast majority of patients owing to the high risk of rupture. Evaluation and management of patients with renal pseudoaneurysm must take into account each individual's circumstances, due to the difficulty of accurately predicting the probability of spontaneous resolution or rupture.

Key Points

  • Renal pseudoaneurysm can arise after injury to the renal artery or one of its branches through trauma, percutaneous kidney biopsy, endourologic procedures, partial nephrectomy, kidney transplantation or endovascular interventions

  • Renal pseudoaneurysm typically presents as flank pain, hematuria or unexplained anemia, although it can be asymptomatic

  • Treatment strategies must be individualized to take into account the heterogeneous location, size, signs and symptoms of renal pseudoaneurysm, as well as its unpredictable clinical course

  • First-line therapy for renal pseudoaneurysm is endovascular selective angioembolization of the affected artery; surgery is indicated for patients with treatment-refractory bleeding

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Figure 1: Abdominal CT scan of a 44-year-old woman with a grade III laceration of the right kidney, which was caused by a road traffic accident.
Figure 2: Angiograms of the right kidney of the patient described in Figure 1.
Figure 3: Proposed algorithm for management of renal pseudoaneurysms.

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Authors and Affiliations

  1. Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, S-287, Stanford, 94305, CA, USA

    Tin C. Ngo, J. Joy Lee & Mark L. Gonzalgo

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Contributions

T. C. Ngo researched data for the article, made a substantial contribution to discussions of the content, wrote the manuscript and participated in review and/or editing of the manuscript before submission. J. J. Lee researched data for the article, made a substantial contribution to discussions of the content and wrote the manuscript. M. L. Gonzalgo made a substantial contribution to discussions of the content and to review and/or editing of the manuscript before submission.

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Correspondence to Mark L. Gonzalgo.

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Ngo, T., Lee, J. & Gonzalgo, M. Renal pseudoaneurysm: an overview. Nat Rev Urol 7, 619–625 (2010). https://doi.org/10.1038/nrurol.2010.163

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