PB1051 - Intervention Strategies for Delayed hemorrhagic complications Caused by Pseudoaneurysm and Arteriovenous Fistula Following Percutaneous Nephrolithotomy: A Case Report.

Background: Percutaneous Nephrolithotomy (PNL) is widely recognized as the minimally invasive gold standard treatment for kidney stones. Massive hematuria caused by renovascular injury has been reported in 0.3-1% of patients. Pseudoaneurysm (PA) with associated arteriovenous fistula (AVF) is a rare, delayed bleeding complication that affects less than 1% of patients after this procedure.

Aims: Determine the best choice of treatment for delayed hemorrhagic complications from PNL

Methods: A 65-year-old man had PNL for a large right kidney stone, with postoperative macroscopic hematuria after one month. After conservative measures proved ineffective, an iatrogenic PA and AVF were diagnosed.
A contrast CT urography revealed a blood clot in the right kidney and ureter, a pseudoaneurysm, and an arteriovenous fistula in the right distal interlobar artery of the right kidney's mid pole.

Results: The angiogram revealed fistula features on the distal interlobar artery from the anterior-inferior segmental arteries, with flow direction to the arcuate renal vein then to the superior cava vein, and fill pseudoaneurisms on the inferolateral side. Superselective angioembolization (SAE) is then performed in the interlobar distal arteries with three coils and one in the pseudoaneurysm ostium. Pseudoaneurysms and arteriovenous fistulas are no longer visible following the embolization.

Conclusion(s): Delayed hemorrhagic complications from PNL can be serious. SAE has a high success rate and a low complication rate for the early detection of renal PA and AVF.