Transfemoral probing of renal artery not possible
- Reason: angle of renal artery origin too steep, marked stenotic resistance
- Suggested solution: Change to transcubital access
“Minor” renal artery rupture
- Occlude renal artery with a dilation balloon for about 10 minutes, then check angiographically
- In case of persistent contrast agent leakage, implant a covered stent or perform end-to-end bypass (ligate the native artery at its origin from the aorta), if needed.
Renal parenchymal perforation
- Occlude segmental artery with a dilation balloon ( 3-4 mm) for 10 to 15 minutes, then check angiographically.
- In case of persistent contrast agent leakage from the parenchyma, expose the kidney by transabdominal dissection and perform hemostasis (consult with a urologist!).
- If logistics permit, attempt embolization
Renal artery occlusion
- Open repair, e.g. bypass
Thrombosis/embolism
- Dissection/plaque rupture due to puncture of highly calcified vessels
- Prevention: Detailed preoperative duplex study of access vessels