Incidence and Risk Factors of Renal Arterial Pseudoaneurysm Post-Robotic Partial Nephrectomy

Overview

In a single-center study of 544 patients undergoing robotic-assisted partial nephrectomy (RaPN), renal artery pseudoaneurysm (RAP) occurred in 2.6% of cases, with 2.2% requiring embolization. The median time to RAP presentation was 9.5 days postoperatively, highlighting the importance of early postoperative monitoring.

Background

Renal cell carcinoma incidence has risen, with partial nephrectomy (PN) being the standard treatment for small renal masses due to its renal function preservation and oncologic equivalence to radical nephrectomy. Robotic-assisted PN (RaPN) offers advantages such as reduced blood loss and shorter hospital stays. However, RAP is a rare but serious complication after PN, typically presenting early with hematuria, flank pain, and anemia. Identifying predictive factors for clinically significant RAP requiring intervention remains a clinical challenge.

Data Highlights

Key Findings

• RAP incidence after RaPN was low at 2.6%, with most cases (2.2%) requiring embolization.
• Median time to RAP symptom onset was approximately 9.5 days post-surgery.
• Both transperitoneal and retroperitoneal approaches were associated with RAP, with a majority in the transperitoneal group.
• Clinical signs prompting RAP diagnosis included gross hematuria, flank pain, and anemia.
• Not all RAP cases required intervention; some were managed conservatively.
• Use of antiplatelet or anticoagulant therapy was noted in some RAP patients, suggesting a potential risk factor.

Clinical Implications

Clinicians should maintain vigilance for RAP in the early postoperative period following RaPN, especially within the first two weeks. Prompt recognition of symptoms such as hematuria and flank pain should trigger imaging evaluation with CT angiography. Transarterial embolization remains an effective treatment for hemodynamically significant RAP, while conservative management may be appropriate for select cases. Preoperative assessment including tumor complexity scores may aid in risk stratification but requires further validation.

Conclusion

Renal artery pseudoaneurysm is an uncommon but potentially serious complication after robotic-assisted partial nephrectomy, typically presenting within two weeks postoperatively. Early diagnosis and appropriate intervention are critical to optimize patient outcomes.

References

1. Epidemiological data on renal cell carcinoma incidence
2. Partial nephrectomy as standard treatment for T1a/T1b renal masses
3. RENAL nephrometry and PADUA scoring systems for tumor complexity
4. Management and outcomes of renal artery pseudoaneurysm post-PN