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Endovascular Revascularization in Pediatric Blunt Renal Vascular Injury: A Case Report
Phuoc Le Nguyen, MD1, John Gray, MD2, Alfred Kennedy, MD2, Ronald Scorpio, MD2. 1Temple University School of Medicine, Philadelphia, PA, 2Geisinger Medical Center, Danville, PA.

Background: Renal vascular injury due to blunt trauma is rare among the pediatric population. Management of the injury remains controversial. We present a case where the patient sustained a blunt renal vascular injury and successfully underwent endovascular revascularization.

Methods: An otherwise healthy 7-year-old boy presented 3 hours after a MVC as a restrained passenger. On presentation, he was hemodynamically stable with a GCS of 15. An abdominal CT demonstrated an isolated Grade 4 right renal artery injury with non-enhancement of the kidney. Initial hemoglobin was 13g/dL and creatinine was 0.7g/dL. Given his stable condition, an isolated renal vascular injury, and a warm ischemic time of 3 hours, a decision was made for an endovascular revascularization. Selective right renal angiography demonstrated a patent proximal renal stump with distal occlusion. The occlusion was crossed with a guidewire and successfully treated with a balloon expandable 4x18 Palmaz stent.

Results: Follow-up angiography revealed normal perfusion to the right kidney 6 hours after the initial injury. Patient was discharged 2 days after surgery. At one month follow up, he remained normotensive and creatinine remained unchanged. Diagnostic renal duplex demonstrated normal flow through the right renal artery.

Conclusions: Our case demonstrates that in a selected pediatric population endovascular revascularization is a viable and efficacious option. Only two case reports of endovascular arterial revascularization exist in the literature. Our case is unique as it is the first report of successful endovascular repair in a pre-pubescent child with prolonged renal ischemia.

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