Pediatric penetrating renal artery trauma: Stent-graft treatment with 2-year follow-up

Purpose: To report the 2-year follow-up of a pediatric patient who underwent stent-graft repair for penetrating renal artery trauma. Case Report: An 11-year-old boy presented with a single anterior abdominal stab wound. He was normotensive (110/70 mmHg) but tachycardic (120 bpm). A focused abdominal sonogram for trauma revealed significant free intraperitoneal fluid. He underwent an urgent laparotomy, during which a minor liver injury was repaired. A large, nonpulsatile, non-expanding, left-sided retroperitoneal hematoma was identified but not explored. The boy remained hemodynamically unstable, so diagnostic angiography was performed. A single left proximal renal artery perforation was found. The lesion was treated with a 6×17-mm balloon-expandable stent-graft. Completion angiography demonstrated an excellent proximal and distal seal, without evidence of extravasation. The patient's condition stabilized, and he recovered completely. Serial renal duplex scans up to 2 years have documented normal renal artery blood flow and no migration of the stent-graft; the kidneys are equal in size. The serum creatinine level remains normal. Conclusion: In appropriately selected patients, transcatheter stent-graft placement is a promising new kidney salvage modality to treat renal artery injury in children. Serious concern remains regarding the placement of covered stents in the pediatric population, as the long-term durability and the adaptability of growing arteries to renal stents are not known.