Top

CardioVascular and Interventional Radiology

Published in:

01-06-2010 | Clinical Investigation

Patients with Life-Threatening Arterial Renal Hemorrhage: CT Angiography and Catheter Angiography with Subsequent Superselective Embolization

Authors: C. M. Sommer, U. Stampfl, N. Bellemann, S. Ramsauer, B. M. Loenard, A. Haferkamp, P. Hallscheidt, G. M. Richter, H. U. Kauczor, B. A. Radeleff

Published in: CardioVascular and Interventional Radiology | Issue 3/2010

Abstract

The purpose of this study was to evaluate the technical and clinical success of superselective embolization in patients with life-threatening arterial renal hemorrhage undergoing preinterventional CT angiography. Forty-three patients with clinical signs of life-threatening arterial renal hemorrhage underwent CT angiography and catheter angiography. Superselective embolization was indicated in the case of a positive catheter angiography. Primary study goals were technical and clinical success of superselective embolization. Secondary study goals were CT angiographic and catheter angiographic image findings and clinical follow-up. The mean time interval between CT angiography and catheter angiography was 8.3 ± 10.3 h (range, 0.2–34.1 h). Arterial renal hemorrhage was identified with CT angiography in 42 of 43 patients (98%) and catheter angiography in 39 of 43 patients (91%) (overview angiography in 4 of 43 patients [9%], selective angiography in 16 of 43 patients [37%], and superselective angiography in 39 of 43 patients [91%]). Superselective embolization was performed in 39 of 43 patients (91%) and technically successful in 37 of 39 patients (95%). Therefore, coil embolization was performed in 13 of 37 patients (35%), liquid embolization in 9 of 37 patients (24%), particulate embolization in 1 of 37 patients (3%), and a combination in 14 of 37 patients (38%). Clinical failure occurred in 8 of 39 patients (21%) and procedure-related complications in 2 of 39 patients (5%). The 30-day mortality rate was 3%. Hemoglobin decreased significantly prior to intervention (P < 0.001) and increased significantly after intervention (P < 0.005). In conclusion, superselective embolization is effective, reliable, and safe in patients with life-threatening arterial renal hemorrhage. In contrast to overview and selective angiography, only superselective angiography allows reliable detection of arterial renal hemorrhage. Preinterventional CT angiography is excellent for detection and localization of arterial renal hemorrhage and appropriate for guidance of the embolization procedure.

Kitase M, Mizutani M, Tomita H et al (2007) Blunt renal trauma: comparison of contrast-enhanced CT and angiographic findings and the usefulness of transcatheter arterial embolization. Vasa 36:108–113CrossRefPubMed

Pappas P, Leonardou P, Papadoukakis S et al (2006) Urgent superselective segmental renal artery embolization in the treatment of life-threatening renal hemorrhage. Urol Int 77:34–41CrossRefPubMed

Dinkel HP, Danuser H, Triller J (2002) Blunt renal trauma: minimally invasive management with microcatheter embolization experience in nine patients. Radiology 223:723–730CrossRefPubMed

Baumann C, Westphalen K, Fuchs H et al (2007) Interventional management of renal bleeding after partial nephrectomy. Cardiovasc Intervent Radiol 30:828–832CrossRefPubMed

Kawashima A, Sandler CM, Corl FM et al (2001) Imaging of renal trauma: a comprehensive review. Radiographics 21:557–574PubMed

Yao DC, Jeffrey RB Jr, Mirvis SE et al (2002) Using contrast-enhanced helical CT to visualize arterial extravasation after blunt abdominal trauma: incidence and organ distribution. AJR Am J Roentgenol 178:17–20PubMed

Chan YC, Morales JP, Reidy JF et al (2008) Management of spontaneous and iatrogenic retroperitoneal haemorrhage: Conservative management, endovascular intervention or open surgery? Int J Clin Pract 62:1604–1613CrossRefPubMed

Mant MJ, O’Brien BD, Thong KL et al (1977) Haemorrhagic complications of heparin therapy. Lancet 1:1133–1135CrossRefPubMed

Dabney A, Bastani B (2001) Enoxaparin-associated severe retroperitoneal bleeding and abdominal compartment syndrome: a report of two cases. Intensive Care Med 27:1954–1957CrossRefPubMed

10.

Isokangas JM, Perala JM (2004) Endovascular embolization of spontaneous retroperitoneal hemorrhage secondary to anticoagulant treatment. Cardiovasc Intervent Radiol 27:607–611CrossRefPubMed

11.

Vignali C, Lonzi S, Bargellini I et al (2004) Vascular injuries after percutaneous renal procedures: treatment by transcatheter embolization. Eur Radiol 14:723–729CrossRefPubMed

12.

Nakasone Y, Ikeda O, Yamashita Y et al (2007) Shock index correlates with extravasation on angiographs of gastrointestinal hemorrhage: a logistics regression analysis. Cardiovasc Intervent Radiol 30:861–865CrossRefPubMed

13.

Sacks D, McClenny TE, Cardella JF et al (2003) Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 14:S199–S202PubMed

14.

Velmahos GC, Chahwan S, Falabella A et al (2000) Angiographic embolization for intraperitoneal and retroperitoneal injuries. World J Surg 24:539–545CrossRefPubMed

15.

Edling NP, Ovenfors CO (1964) Intentional embolism in selective renal arteriography. An experimental study in dogs. Acta Radiol Diagn 2:316–320

16.

Pathi R, Voyvodic F, Thompson WR (2004) Spontaneous extraperitoneal haemorrhage: computed tomography diagnosis and treatment by selective arterial embolization. Australas Radiol 48:123–128CrossRefPubMed

17.

Dondelinger RF, Trotteur G, Ghaye B et al (2002) Traumatic injuries: radiological hemostatic intervention at admission. Eur Radiol 12:979–993CrossRefPubMed

18.

Chatziioannou A, Brountzos E, Primetis E et al (2004) Effects of superselective embolization for renal vascular injuries on renal parenchyma and function. Eur J Vasc Endovasc Surg 28:201–206PubMed

19.

Takebayashi S, Hosaka M, Kubota Y et al (1998) Transarterial embolization and ablation of renal arteriovenous malformations: efficacy and damages in 30 patients with long-term followup. J Urol 159:696–701CrossRefPubMed

20.

Cynamon J, Atar E, Steiner A et al (2003) Catheter-induced vasospasm in the treatment of acute lower gastrointestinal bleeding. J Vasc Interv Radiol 14:211–216PubMed

21.

Mohsen T, El-Assmy A, El-Diasty T (2008) Long-term functional and morphological effects of transcatheter arterial embolization of traumatic renal vascular injury. BJU Int 101:473–477PubMed

22.

Chang YH, Wang LJ, Chuang CK et al (2007) The efficacy and outcomes of urgent superselective transcatheter arterial embolization of patients with ruptured renal angiomyolipomas. J Trauma 62:1487–1490CrossRefPubMed

23.

Katsumata A, Kusaka N, Sugiu K et al (2001) Use of the GDC for embolization of a tumor fed by a cavernous branch of the internal carotid artery. No Shinkei Geka 29:565–569PubMed

24.

Reed A, Suri R, Marcovich R (2007) Passage of embolization coil through urinary collecting system one year after embolization. Urology 70:e17–e18CrossRefPubMed

25.

Mahaffey KG, Bolton DM, Stoller ML (1994) Urologist directed percutaneous nephrostomy tube placement. J Urol 152:1973–1976PubMed

26.

Rubin GD (2001) Techniques for performing multidetector-row computed tomographic angiography. Tech Vasc Interv Radiol 4:2–14CrossRefPubMed

27.

Adam DJ, Fitridge RA, Raptis S (2005) Intra-abdominal packing for uncontrollable haemorrhage during ruptured abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 30:516–519CrossRefPubMed

28.

Meyerovitz MF, Levin DC, Boxt LM (1985) Superselective catheterization of small-caliber arteries with a new high-visibility steerable guide wire. AJR Am J Roentgenol 144:785–786PubMed

29.

Sugar O (1978) Superselective angiography. JAMA 240:1271–1272CrossRefPubMed

30.

Jakob SM, Tenhunen JJ, Heino A et al (2002) Splanchnic vasoregulation during mesenteric ischemia and reperfusion in pigs. Shock 18:142–147CrossRefPubMed

Title: Patients with Life-Threatening Arterial Renal Hemorrhage: CT Angiography and Catheter Angiography with Subsequent Superselective Embolization
Authors: C. M. Sommer
U. Stampfl
N. Bellemann
S. Ramsauer
B. M. Loenard
A. Haferkamp
P. Hallscheidt
G. M. Richter
H. U. Kauczor
B. A. Radeleff
Publication date: 01-06-2010
Publisher: Springer-Verlag
Published in: CardioVascular and Interventional Radiology / Issue 3/2010
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-009-9787-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Patients with Life-Threatening Arterial Renal Hemorrhage: CT Angiography and Catheter Angiography with Subsequent Superselective Embolization

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2010

Whole-Body Magnetic Resonance Angiography with Additional Steady-State Acquisition of the Infragenicular Arteries in Patients with Peripheral Arterial Disease

Reply to the Queries Regarding Our Article Entitled “Endovascular Repair of a Traumatic Axillary Artery Pseudoaneurysm”

Impact of Stent Design on In-Stent Stenosis in a Rabbit Iliac Artery Model

A Comparison of Transjugular and Plugged-Percutaneous Liver Biopsy in Patients with Contraindications to Ordinary Percutaneous Liver Biopsy and an “In-House” Protocol for Selecting the Procedure of Choice

Endograft Collapse After Endovascular Treatment for Thoracic Aortic Disease

Sloughing of Intraductal Tumor Thrombus of Hepatocellular Carcinoma After Transcatheter Arterial Chemoembolization