Traumatic renal injuries: the prevalence, management and outcome of renal vascular injury

Purpose To assess the prevalence, management and outcome of renal vascular injuries (RVIs; active bleeding and contained vascular injuries) seen on admission CT. Also, we wanted to find out the prevalence and survival of patients with concomitant injury to liver, spleen, and kidney seen on admission CT. Methods We conducted a retrospective, single-center, longitudinal cohort study with nine-year data (2013–2021) of all ≥ 15-year-old patients with renal injury identified in a trauma registry. Admission CT and angiographic examinations were reviewed to assess RVIs, including active bleeding, arterial dissection, segmental infarct, pseudoaneurysm or AV-fistulae. Medical records were reviewed for treatment, hospital length of stay and 30-day survival rate. Results Out of 2805 patients with abdominal trauma, 243 (8.7%) had a renal injury, of whom 182 (74.9%) underwent CT on admission. RVI was found in 56 patients (30.8%). Among these 56 patients, 42 (75%) had active bleeding, eight (14.3%) segmental infarct, six (10.7%) pseudoaneurysm, and three (5.4%) arterial dissection. Of these, ten patients (17.9%) underwent angioembolization, and three (5.4%) underwent laparotomy. Patients with RVI were slightly older than those without RVI (43.6 vs. 37.8 years, p = 0.0409) and had more often a penetrating trauma (OR 2.836; 95% CI 1.127–7.136, p = 0.0416). Hospital length of stay (14.7 vs. 14.9 days, p = 0.9520) and 30-day survival (95.2% vs. 92.6%, p = 0.3165) did not differ significantly between patients without and with RVI. Among patients with available CT, fourteen (14/182; 7.7%) had concomitant injuries to the liver, spleen and kidney, with no statistically significant difference in 30-day survival compared with patients without such concomitant injuries (92.9% vs. 94.6%; p = 0.5237). Conclusion RVI was not uncommon in our study cohort, occurring in 30.8% of patients with renal injury who underwent CT on admission. Of these, 17.9% were treated with angioembolization. Patients with RVI were slightly older and were more likely to have a penetrating injury than patients without RVI. No statistically significant difference in hospital length of stay or 30-day survival was found between patients without and with RVI.