Contemporary management of blunt renal artery injuries.

BACKGROUND: Management of blunt renal artery injury has evolved with advances in imaging and endovascular therapy. We characterized contemporary management strategies and the evolving role of endovascular therapy in renal preservation. METHODS: Adult patients with blunt renal artery injury were identified in the TQIP database (2018-2023) and categorized into four groups: nonoperative, endovascular, open renal preservation, or nephrectomy. Multivariable regression identified predictors of endovascular intervention and mortality. RESULTS: Among 2118 patients, nonoperative management was most common (70.4%), followed by endovascular therapy (21.1%); nephrectomy (6.6%) and open repair (1.9%) were uncommon. Nephrectomy was associated with more complications and longer stays. Treatment strategy was not independently associated with mortality. Increasing Injury Severity Score predicted mortality, while isolated renal injury predicted lower mortality. Older age, male sex, and isolated renal injury independently predicted endovascular intervention. CONCLUSIONS: Endovascular therapy has become the predominant invasive strategy for blunt renal artery injury, with treatment approach not independently affecting mortality.