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Background
The most common malignant neoplasm involving the kidney is renal cell carcinoma, and the most common subtype is clear cell. For patients with a focal renal mass resection of the mass either via partial or total nephrectomy is typically performed to confirm a diagnosis. We present a case of a 102-year-old woman with a history of dementia, hypertension, and hyperlipidemia with complaints of 2 months of worsening hematuria which required multiple blood transfusions and hospitalizations. A CT demonstrated a 6-cm solid lesion in the left upper pole of the kidney, which was concerning for malignancy. Patients presenting with metastatic disease can obtain a diagnosis via a biopsy of a metastatic lesion. Ablation was considered but not ideal given the size of the tumor and peripheral location. It was therefore recommended that the patient undergo a less invasive embolization of the renal mass.

Educational Goals / Teaching Points
Balloon malfunction and complications in this case, there was a malfunction of the antireflux balloon, which resulted in a kink in the catheter. Efforts to refill and empty the balloon were unsuccessful, and ultimately, the decision was made to cut and forcibly remove the balloon. This led to the formation of a pseudoaneurysm, which required additional coil embolization to occlude the vessel.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A sniper antireflux microcatheter was utilized to select segmental branches of the upper pole and midpole renal arteries. An antireflux balloon was utilized to limit non target embolization after which an absolute alcohol and Lipiodol emulsion was instilled for liquid embolization. Additionally, microcoils were also deployed. Following embolization, multiple unsuccessful attempts were made to refill and empty to deflate the antireflux catheter balloon due to a kink in the catheter. Therefore, proximal to the kink, the catheter was cut. The balloon would still not deflate and was forcibly pulled and removed. A repeat arteriogram was then performed demonstrating a small pseudoaneurysm at the site of the balloon. The vessel was recatheterized, and additional coils were utilized to occlude the pseudoaneurysm. Another arteriogram was then performed which confirmed preservation of flow in the left kidney with decreased perfusion of the left upper pole mass.

Conclusion
Follow-up CT of the abdomen pelvis demonstrated pooling of Lipiodol within the upper pole of the left kidney with complete dense contrast staining of the renal mass. In the setting of balloon malfunction the first steps are to refill/empty the balloon. If the balloon continues to malfunction cutting and pulling it are the next options. In our case we had to resort to pulling the catheter which led to pseudoaneurysm formation and subsequent coil embolization. This complication had no long-term side effects on our patient and she has not required hospitalization or a transfusion since the procedure.