During percutaneous nephrostomy (PCN), the preferred access route to minimize vascular injury is:

• A Entry through the posterior (dorsal) calyx in the avascular plane of Brödel's line (posterior parenchymal watershed) ✓
• B Direct puncture of the renal pelvis through an anterior calyx
• C Superior pole calyx puncture to access the renal pelvis
• D Puncture through the renal hilum directly into the pelvis

Explanation

Brödel's bloodless line is the plane along the posterior aspect of the kidney between the anterior and posterior segmental arteries, representing the watershed zone with the least vascularity. PCN access through a posterior calyx in this plane (typically the middle or lower pole posterior calyx) minimizes arterial injury. Anterior calyx puncture risks major vessel injury. Superior pole puncture risks pleural transgression. Direct hilar puncture carries high risk of major vascular injury and injury to collecting structures. Correct calyceal access in PCN is both a radiation and surgical principle.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.