Life threatening acute complication after routine catheter exchange—The importance of planning and preparedness in risk cases

Endovascular procedures after abdominal surgery may carry risks for serious complications. Radical nephrectomy is preferred for renal cell carcinomas but carries risks including hemorrhage (1.2%), abscesses (0.7%-6.1%). Percutaneous abdominal drainage procedures carry hemorrhagic risks in 1%-2% of cases. An 88-year-old male with recent left sided nephrectomy developed a retroperitoneal abscess requiring drainage. During routine catheter upsizing, massive hemorrhage occurred due to injury of the left renal artery stump by the larger catheter. Emergency endovascular intervention was performed. Initial aortic stent graft placement alone proved insufficient due to anatomical constraints. Complete hemostasis was achieved through adding coil embolization of the arterial stump, while the partial stent coverage prevented coil migration. This case emphasizes that routine interventional procedures can precipitate life-threatening complications even in experienced hands.