Renal Artery Perforation

A 73-year-old woman developed abdominal distention, pain with pallor, and hypotension after successful primary percutaneous coronary intervention with 1 drug-eluting stent. Emergent blood tests and abdominal imaging confirmed right perirenal hemorrhage. Selective renal angiogram revealed ongoing bleeding from a distal renal artery perforation when her clinical condition deteriorated despite conservative management. A vascular plug device was deployed in a renal branch supplying the bleeding area, because direct access to the perforated distal vessel was not feasible, and successfully stopped the fatal bleeding. This case provides insights into managing iatrogenic renal artery perforations, which is important as renal artery-related interventions become more widespread.