Superselective renal artery embolization for complex duplex kidney with multiple prior surgeries: a case report

Duplex kidney is a common congenital malformation appearing as duplication of the renal pelvis and ureter. However, complex cases with a history of multiple abdominal surgeries, extensive perirenal adhesions, aberrant vascular anatomy, and long-term anticoagulation remain challenging to manage, and no standardized protocol currently exists. Herein, we report a 54-year-old female patient with a complex duplex kidney who had a history of multiple previous abdominal and renal surgeries, long-term oral warfarin anticoagulation, and concurrent recurrent urinary tract infections, renal abscess, and upper urinary tract stones. Following multidisciplinary team evaluation, traditional heminephrectomy was considered extremely high-risk; consequently, superselective renal artery embolization was performed as definitive treatment. The patient recovered uneventfully without major complications. At 12-month follow-up, all symptoms completely resolved, renal function remained stable, and no recurrence of infection or stones was observed. This case suggests that for patients with complex duplex kidney at high surgical risk, superselective renal artery embolization is a safe and feasible minimally invasive alternative, and may inform individualized clinical decision-making.