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01-04-2014 | Vascular and Interventional Radiology

Transcatheter embolisation of iatrogenic renal vascular injuries

Authors: Anna Maria Ierardi, Chiara Floridi, Federico Fontana, Ejona Duka, Antonio Pinto, Mario Petrillo, Elias Kehagias, Dimitrios Tsetis, Luca Brunese, Gianpaolo Carrafiello

Published in: La radiologia medica | Issue 4/2014

Abstract

Purpose

The aim of our study was to review our experience and long-term follow-up in the treatment of iatrogenic renal vascular injuries using transcatheter embolisation.

Materials and methods

Our retrospective analysis of cases collected in two interventional centres consists of a total of 21 patients who underwent renal arterial embolisation (RAE) for iatrogenic arterial kidney bleeding. Biopsy (n = 4), percutaneous nephrolithotomy (n = 4), nephron-sparing surgery (n = 4), guidewire-induced arterial perforation during coronary angiography or renal stenting (n = 3), percutaneous nephrostomy (n = 3), renal endopyelotomy/pyeloplasty (n = 2) and surgical nephrectomy were the iatrogenic causes. Seven patients presented with haemodynamic instability requiring blood transfusion (33.3 %), the remaining were haemodynamically stable (66.7 %). Diagnostic renal angiography revealed 9 actively bleeding vessels, 6 pseudoaneurysms, 4 arteriovenous fistulas and 1 arterio-calyceal fistula. In one patient selective renal arteriography was negative probably because the bleeding observed at CT angiography was self-limited. Twenty-one embolisation procedures were performed in 20 patients; one patient required a second embolisation 3 h after the first one. Embolisation was performed with microcoils, polyvinyl alcohol particles, embospheres, spongostan emulsion and vascular plug.

Results

The technical success rate was 100 %. The overall clinical success rate was 95 %. Apart from a patient who died due to disseminated intravascular coagulation, no major complications requiring intensive care treatment were encountered during or after the procedures. No patient required emergency surgery or subsequent surgical treatment. No statistically significant differences in eGFR or renal function stage appeared after RAE.

Conclusions

Percutaneous treatment can be proposed as a first-line treatment in iatrogenic renal arterial injuries, resulting in a safe and effective procedure.

Somani BK, Nabi G, Thorpe P, McClinton S (2006) Endovascular control of haemorrhagic urological emergencies: an observational study. BMC Urol 6:27PubMedCentralPubMedCrossRef

Morris CS, Bonnevie GJ, Najarian KE (2001) Nonsurgical treatment of acute iatrogenic renal artery injuries occurring after renal artery angioplasty and stenting. AJR Am J Roentgenol 177:1353–1357PubMedCrossRef

Cohenpour M, Strauss S, Gottlieb P et al (2007) Pseudoaneurysm of the renal artery following partial nephrectomy: imaging findings and coil embolization. Clin Radiol 62:1104–1109PubMedCrossRef

Poulakis V, Ferakis N, Betch E et al (2006) Treatment of renal vascular injury by transcatheter embolization: immediate and longterm effects on renal function. J Endourol 20:405–409PubMedCrossRef

Mavili E, Do¨nmez H, Özcan N et al (2009) Transarterial embolization for renal arterial bleeding. Diagn Interv Radiol 15:143–147PubMed

Cantasdemir M, Adaletli I, Cebi D et al (2003) Emergency endovascular embolization of traumatic intrarenal arterial pseudoaneurysms with N-butyl cyanoacrylate. Clin Radiol 58:560–565PubMedCrossRef

Levey AS, Coresh J, Balk E et al (2003) National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. National Kidney Foundation. Ann Intern Med 139:137–147PubMedCrossRef

Sacks D, McClenny TE, Cardella JF et al (2003) Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 14(suppl):S199–S202PubMedCrossRef

Permpongkosol S, Link RE, Su LM et al (2007) Complications of 2775 urological laparoscopic procedures: 1993 to 2005. J Urol 177:580e5CrossRef

10.

Heye S, Maleux G, Van Poppel H et al (2005) Hemorrhagic complications after nephron-sparing surgery: angiographic diagnosis and management by transcatheter embolization. AJR Am J Roentgenol 184:1661e4CrossRef

11.

Huppert PE, Duda SH, Erley CM et al (1993) Embolization of renal vascular lesions: clinical experience with microcoils and tracker catheters. Cardiovasc Interv Radiol 16:361–367CrossRef

12.

Golzarian J, Sapoval MR, Kundu S et al (2010) Guidelines for peripheral and visceral vascular embolization training: joint writing groups of the Standards of Practice Committees for the Society of Interventional Radiology (SIR), Cardiovascular and Interventional Radiological Society of Europe (CIRSE), and Canadian Interventional Radiology Association (CIRA). J Vasc Interv Radiol 21:436–441PubMedCrossRef

13.

Cimsit NC, Baltacioglu F, Cengic I et al (2008) Transarterial glue embolization in iatrogenic renovascular injuries. Int Urol Nephrol 40:875–879PubMedCrossRef

14.

Sam K, Gahide G, Soulez G et al (2011) Percutaneous embolization of iatrogenic arterial kidney injuries: safety, efficacy, and impact on blood pressure and renal function. J Vasc Interv Radiol 22:1563–1568PubMedCrossRef

15.

16.

Mavili E, Dönmez H, Ozcan N et al (2009) Transarterial embolization for renal arterial bleeding. Diagn Interv Radiol 15:143–147PubMed

17.

Maleux G, Messiaen T, Stockx L et al (2003) Transcatheter embolization of biopsy-related vascular injuries in renal allografts long-term technical, clinical and biochemical results. Acta Radiol 44:13–17PubMed

18.

Singh D, Gill IS (2005) Renal artery pseudoaneurysm following laparoscopic partial Negoro. J Urol 174:2256e9

19.

Yamakado K, Nakatsuka A, Tanaka N et al (2000) Transcatheter arterial embolization of ruptured pseudoaneurysms with coils and nbutyl cyanoacrylate. J Vasc Interv Radiol 11:66–72PubMedCrossRef

20.

Parildar M, Oran I, Memis A (2003) Embolization of visceral pseudoaneurysms with platinum coils and N-butyl cyanoacrylate. Abdom Imaging 28:36–40PubMedCrossRef

21.

Sofocleous CT, Hinrichs C, Hubbi B et al (2005) Angiographic findings and embolotherapy in renal arterial trauma. Cardiovasc Interv Radiol 28:39–47CrossRef

22.

El-Nahas A, Shokeir A, Mohsen T et al (2008) Functional and morphological effects of postpercutaneous nephrolithotomy superselective renal angiographic embolization. Urology 71:408–412PubMedCrossRef

23.

Loffroy R, Guiu B, Lambert A et al (2008) Management of post-biopsy renal allograft arteriovenous fistulas with selective arterial embolization: immediate and long-term outcomes. Clin Radiol 63:657–665PubMedCrossRef

24.

Baldieri A, Antonietti A, Ferro L et al (2012) Endovascular treatment of visceral artery aneurysms and pseudoaneurysms: our experience. Radiol Med 117:815–830CrossRef

25.

Pozzi-Mucelli F, Medeot A, Cernic S et al (2011) Multimodal approach to the endovascular treatment of embolisation or exclusion of the renal arteries and their distal and/or polar branches: personal experience. Radiol Med 116:945–959PubMedCrossRef

Title: Transcatheter embolisation of iatrogenic renal vascular injuries
Authors: Anna Maria Ierardi
Chiara Floridi
Federico Fontana
Ejona Duka
Antonio Pinto
Mario Petrillo
Elias Kehagias
Dimitrios Tsetis
Luca Brunese
Gianpaolo Carrafiello
Publication date: 01-04-2014
Publisher: Springer Milan
Published in: La radiologia medica / Issue 4/2014
Print ISSN: 0033-8362
Electronic ISSN: 1826-6983
DOI: https://doi.org/10.1007/s11547-013-0343-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Transcatheter embolisation of iatrogenic renal vascular injuries

Abstract

Purpose

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

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