From Clot to Cure: Navigating Vascular Pitfalls With Endovascular Salvage of a Delayed Renal Artery Pseudoaneurysm Following High-Energy Renal Trauma

Renal artery pseudoaneurysm (RAP) is a rare but potentially life-threatening vascular complication of high-grade renal trauma, often presenting with delayed or nonspecific symptoms. While non-operative management (NOM) remains the standard for stable renal injuries, RAP demands timely endovascular or surgical intervention to prevent hemorrhage and preserve renal function. We present the case of a 19-year-old male with a Grade III right renal injury following blunt abdominal trauma, initially managed conservatively. Forty days post-injury, he developed anuria, suprapubic pain, and bladder distension despite an indwelling Foley catheter. Imaging revealed a large RAP (5.3 × 3.6 cm) and a significant bladder clot (9 × 6 × 5 cm). Initial coil embolization of the middle polar artery branch was unsuccessful. Temporary relief was achieved with glue embolization, but recurrent hematuria necessitated the placement of a covered stent graft, which effectively excluded the pseudoaneurysm. The patient remained asymptomatic on follow-up. This case underscores the evolving management of RAP and the limitations of conventional embolization techniques. The progressive approach, from coil embolization to glue and ultimately covered stent placement, achieved durable hemostasis while preserving renal parenchyma. Delayed RAP requires a high index of suspicion, prompt imaging, and a multidisciplinary treatment strategy. Nephron-sparing endovascular techniques like covered stent grafting offer an effective solution in cases where primary embolization fails. This report highlights the critical role of minimally invasive vascular interventions in managing complex renal vascular trauma.