Incidental pseudoaneurysm - post-partial nephrectomy, in an asymptomatic patient

Corresponding author: Thilagavathi M. Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0. Incidental pseudoaneurysm - post-partial nephrectomy, in an asymptomatic patient Thilagavathi M 1, * , Divakar S 1 and Akshayavarsheeni S 2 1 Sri Ramachandra Faculty of Allied Health Sciences, Division of Urology Technology , Sri Ramachandra Institute of Higher Education And Research, Chennai, Tamil Nadu, India. 2 Saveetha college of Allied Health Sciences, Thandalam, Chennai, Tamil Nadu. India. World Journal of Advanced Research and Reviews, 2025, 26(03), 1429-1432 Publication history: Received on 27 April 2025; revised on 12June 2025; accepted on 14June 2025 Article DOI: https://doi.org/10.30574/wjarr.2025.26.3.2313 Abstract A52-year-old women who had a partial removal of her left kidney a year ago for a renal tumor was asymptomatic and under routine follow-up. During her recent check-up, a contrast enhanced CT scan of her abdomen showed a large pseudoaneurysm in the left renal artery, measuring approximately 79mm by 67mm by 78mm. Because of its size, the medical team performed a safe angioembolization procedure, which went smoothly without any complications. Keywords: Asymptomatic; Angioembolization; Angiography; Pseudoaneurym; Partial nephrectomy; Renal tumour 1. Introduction Partial nephrectomy is the treatment of choice for small renal tumors, however ,it may result in iatrogenic renal vascular injury which might lead to the formation of life-threatening complications like renal artery pseudoaneurysm .(1) Renal artery pseudoaneurysm may also form after percutaneous renal procedures and renal trauma. (2) The incidence is slightly higher in laparoscopic compared to the open partial nephrectomy.(3) The most common presentation is hemorrhage. We present a case of large asymptomatic renal artery pseudoaneurysm in a 52–year –old female detected incidentally 1 year after partial nephrectomy performed for renal tumor. 2. Case report A 52-year –old female underwent left open partial nephrectomy one year ago for a 2-cm left renal mass. Histopathology confirmed clear cell renal cell carcinoma (p T1 NxMx). The patient remained asymptomatic during the postoperative period. During a routine follow up, a contrast-enhanced computed tomography (CT) of the abdomen revealed a large pseudoaneurysm measuring 79mm x 67mm x78mm. Renal CT angiography showed a large pseudoaneuysm, measuring 8.5cm x 7.1 cm x6.7 cm, located at the upper pole of the left kidney and supplied by the anterior superior segmental artery (Figure 1a-f). World Journal of Advanced Research and Reviews, 2025, 26(03), 1429-1432 1430 a) Coronal noncontrast CT image of the abdomen demonstrating a left renal arterial pseudoaneurysm (whit arrow) b) Renal arterial pseudoaneurysm observed in the corticomedullary phase c) Image showing the pseudoaneurysm with an arterial blush d) Image illustrating the pseudoaneurysm with an arterial blush e) Axial CT image of the abdomen in the nephrogenic phase displaying the left renal pseudoaneurysm f) Axial plane image showing the left renal arterial pseudoaneurysm with arterial blush Figure 1 Pseudoaneurysm in renal computed tomography angiography World Journal of Advanced Research and Reviews, 2025, 26(03), 1429-1432 1431 Due to the large size of the pseudoaneurysm, therapeutic angioembolization was performed (Figure 2a and b). A followup CT angiography obtained one week after the embolization demonstrated sequelae of the pseudoaneurysm without any evidence of active bleeding (Figure 2c and d). a) Intraoperative fluoroscopy image showing the left renal arterial pseudoaneurysm with active arterial blush b) Fluroscopic image after embolization demonstrating the absence of active arterial blush in the left renal artery c) Post embolization CT image showing the left renal arterial pseudoaneurysm without any active bleeding d) Post embolization CT image highlighting postprocedure sequelae Figure 2 Before and after images of angioembolization, post-embolization computed tomography angiography 3. Discussion Renal artery pseudoaneurysm is rare and potentially life-threatening complication following partial nephrectomy. Most patients present with hematuria or abdominal pain, whereas asymptomatic pseudoaneurysms are uncommon. CT World Journal of Advanced Research and Reviews, 2025, 26(03), 1429-1432 1432 angiography is the investigation of choice for diagnosis. Treatment options include observation, aneurysmectomy with surgical repair, endovascular procedures, and partial or total nephrectomy. Observation is indicated in hemodynamically stable patients with asymptomatic aneurysms and has emerged as a simple, useful, and effective modality for managing pseudoaneurysms.(4) 4. Conclusion Large renal artery pseudoaneurysms can be asymptomatic. When detected, they can be effectively managed with endovascular procedures. Compliance with ethical standards Disclosure of conflict of interest We declare that there is No conflict of interest to disclose. Statement of informed consent The authors certify that they have obtained all appropriate patient consent forms. In these forms, the patient(s) have given consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published, and every effort will be made to conceal their identities; however, complete anonymity cannot be guaranteed. References [1] Swana HS, Cohn SM, Burns GA, Egglin TK. Renal artery pseudoaneurysm after blunt abdominal trauma: Case report and literature review. J Trauma 1996; 40:459-61. [2] Kessaris DN, Bellman GC, Pardalidis NP, Smith AG. Management of hemorrhage after percutaneous renal surgery. J Urol1995; 153:604-8. [3] Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR Jr., et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol2007; 178:41-6. [4] Singh D, Gill IS. Renal artery pseudoaneurysm following laparoscopic partial nephrectomy. J Urol2005; 174:2256-9.