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European Radiology
Published in: European Radiology 4/2015

01-04-2015 | Vascular-Interventional

A multicentre retrospective study of transcatheter angiographic embolization in the treatment of delayed haemorrhage after percutaneous nephrolithotomy

Authors: Long Li, Yan Zhang, Yong Chen, Kang-Shun Zhu, De-Ji Chen, Xin-Qiao Zeng, Xiao-Bai Wang

Published in: European Radiology | Issue 4/2015

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Abstract

Objective

The objective is to determine the timing and indications of transcatheter angiographic embolization (TAE) for delayed haemorrhage after percutaneous nephrolithotomy (PCNL).

Methods

The medical records of 144 patients who underwent arteriography and TAE for delayed post-PCNL haemorrhage at five university hospitals between January 2005 and December 2012 were reviewed retrospectively.

Results

The mean time to the onset of post-PCNL haemorrhage was 10.5 days (2 - 30 days). Clinical presentation included sudden onset bleeding in 51 patients (35.4 %), intermittent bleeding in 67 patients (46. 5 %), and continuous slow bleeding in 26 patients (18.1 %). Hemodynamic instability occurred in 32 patients (22.2 %). The mean haemoglobin decrease from the first post-PCNL day to the day of TAE was 49.5 g/L (31.0 - 79.0 g/L). Renal arteriography showed pseudoaneurysms in 69 (47.9 %) patients, arteriovenous fistulas in 28 (19.4 %) patients, mixed arterial and arteriovenous lesions in 17 (11.8 %) patients, arterial lacerations in 23 (16.0 %) patients, and negative angiographic finding in seven (4.9 %) patients. TAE was successful in stopping bleeding in all 137 patients with vascular lesions. There were no major complications associated with TAE.

Conclusions

TAE should be the recommended treatment for delayed post-PCNL haemorrhage in patients with hemodynamic instability and/or corrected haemoglobin decrease >30 g/L following conservative management.

Key Points

• Delayed haemorrhage after percutaneous nephrolithotomy occurs more than 24 hours postoperatively.
• Angio-embolization is a safe and effective treatment for delayed post-PCNL haemorrhage.
• Angio-embolization can treat hemodynamic instability and/or corrected haemoglobin decrease >30 g/L.
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Metadata
Title
A multicentre retrospective study of transcatheter angiographic embolization in the treatment of delayed haemorrhage after percutaneous nephrolithotomy
Authors
Long Li
Yan Zhang
Yong Chen
Kang-Shun Zhu
De-Ji Chen
Xin-Qiao Zeng
Xiao-Bai Wang
Publication date
01-04-2015
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 4/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-014-3491-4

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