Renal artery cannot be probed via transfemoral access
- Reason: angle of renal artery origin too steep, marked stenotic resistance
- Suggested solution: Change to transcubital access
"Minor" renal artery rupture
- Occlude the renal artery with a dilation balloon for about 10 minutes, then perform check angiography
- In case of persistent contrast agent leakage, implant a covered stent or perform reconstruction with an end-to-end bypass (ligate the native artery at its origin from the aorta), if needed.
Renal parenchymal perforation
- Occlude the segmental artery with a dilation balloon (3–4 mm) for 10 to 15 minutes, then perform check angiography
- In case of persistent contrast agent leakage from the parenchyma, expose the kidney by transabdominal dissection and perform haemostasis (consult a urologist!)
- If logistics permit, attempt embolisation
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 the access vessels