EVOH embolization of relapsing traumatic kidney vascular injury after stent grafting

Baseline Central

A 45 year old male patient was admitted to emergency department and underwent total body CT after a motorcycle accident. CT scans showed an AAST IV grade right kidney lesion.

In particular, an abundant contrast extravasation was detected swelling a large perirenal haematoma.

First Treatment

At angiography, a pseudoaneurysm was seen in the distal part of main renal artery, directly connected to an extravasating segmental branch. The lesion was successfully excluded by positioning a 6x16 mm balloon expandable (PTFE) covered stent.

Second Treatment

Nevertheless, a CT scan at 20 days showed residual patency of vascular lesions despite the stable position of the stent graft with an AVF appearing in place of the previous extravasation

A torqueable Direxion™ Bern-Shape was chosen and easily introduced between the stent graft and the vessel wall into the pseudoaneurysm over a microguidewire, thanks to its pushability and torque control.


After evaluating possible communication with unharmed segmental vessels and flushing the microcatheter with the solvent DMSO, 0.6 ml of EVOH copolymer was slowly injected to completely fill the AVF and the pseudoaneurysm itself, with a good performance of the microcatheter.

At final angiogram, complete embolization of pseudoaneurysm and AVF was shown, saving patency of main renal artery.

Study and images courtesy of
Dott. Giampiero Bonatti – Chief of Radiology department and Interventional Radiologist – Azienda Sanitaria dell’Alto Adige – Bolzano
Dott. Alessio Comai - Dott. Thomas Haglmueller – Interventional Radiologist – Azienda Sanitaria dell’Alto Adige – Bolzano