1688: Hemorrhage Following Percutaneous Renal Surgery: Characterization of Angiographic Findings

Richstone, Lee; Fossett, Lindsay K.; Okeke, Zeph; Ost, Michael C.; Rastinehad, Ardeshir R.; Lobko, Igor; Siegel, David; Kavoussi, Louis R.; Smith, Arthur D.

doi:10.1016/s0022-5347(18)31876-7

Cited by 9 publications

(14 citation statements)

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“…Rastogi et al (16) reported a case with a combination of AVF and caliceovenous fistula after PCNL and pointed out that serum creatinine values increased in this patient. However, caliceovenous fistula was self-limiting unlike arterial bleeding (14,15,17).…”

Section: Discussionmentioning

confidence: 99%

“…However, it should be noted that occasionally complications may occur a long time after the intervention. Richstone et al (14) reported that 57 out of 4695 patients (1.2%) required selective endovascular embolization following percutaneous renal interventions (PCNL was the etiology for 44 of 57 patients). Srivastava et al (15) reported embolization after PCNL in 24 out of 1854 patients and found a combination of PA and AVF in four cases.…”

Section: Discussionmentioning

confidence: 99%

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Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

Güneyli¹,

Gök²,

Bozkaya³

et al. 2015

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to evaluate iatrogenic renal arterial lesions, including pseudoaneurysm, arteriovenous fistula, and arteriocaliceal fistula, their management by endovascular embolization, and the clinical results. METHODSFifty-five patients (forty males, fifteen females) with a median age of 40 years (range, 8-85 years), who underwent endovascular embolization of iatrogenic renal arterial lesions between March 2003 and December 2013 were included in this retrospective study. Types of iatrogenic lesions and details of embolization procedures were reported. Estimated glomerular filtration rate (eGFR), renal function tests, hemoglobin, and hematocrit levels before and after embolization were recorded and compared. RESULTSMedian follow-up was 24 months. We identified 53 pseudoaneurysms, 30 arteriovenous fistulas, and 11 arteriocaliceal fistulas in 55 patients, after percutaneous nephrolithotomy (n=26), renal biopsy (n=21), nephrostomy (n=3), renal surgery (n=3), and extracorporeal shock wave lithotripsy (n=2). Median number of pseudoaneurysms was 1 (range, 1-4) with a median size of 7 mm (range, 1.5-35 mm). Fifty-one patients underwent coil embolization. Median number of coils was 5 (range, 2-21) and median renal parenchymal loss was 5% (range, 1%-50%). There were no significant differences between pre-and postoperative eGFR and serum parameters. CONCLUSION Iatrogenic renal arterial lesion can be a life threatening condition. Superselective coil embolization is a safe, minimally invasive treatment option with minimal renal parenchymal loss and without significant change in renal function. Iatrogenic renal arterial lesions including pseudoaneurysm (PA), arteriovenous fistula (AVF), and arteriocaliceal fistula (ACF) are rare, but life-threatening conditions (1). The chief symptom usually includes macroscopic hematuria (2, 3). Catheter angiography is the gold standard for both diagnosis and treatment (1).Previous studies have evaluated the iatrogenic renal arterial lesions following partial nephrectomy (1, 3-7), but there were only a few studies on iatrogenic renal arterial lesions following any iatrogenic renal interventions (2). In the present study, to the best of our knowledge, we report the largest series of iatrogenic renal arterial lesions following various renal interventions such as biopsy, percutaneous nephrolithotomy (PCNL), percutaneous nephrostomy, and partial nephrectomy. We focused on clinical presentations, imaging findings, management, and outcomes. Methods PatientsData regarding iatrogenic renal arterial lesions treated by endovascular embolization performed at our institution between March 2003 and December 2013 were evaluated retrospectively. A total of 55 patients with iatrogenic renal arterial lesions, who underwent endovascular embolization were included in the study. There were 40 males and 15 females with a median age of 40 years (range, 8-85 years). Patients with traumatic renal arterial lesions treated with endovascular embolization were excluded from the study. Informed con...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

Güneyli¹,

Gök²,

Bozkaya³

et al. 2015

Diagn Interv Radiol

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“…Mechanisms for formation of RAP have been proposed and previously described in detail [16,27] The present study is limited by its retrospective nature and the relatively small number of delayed haemorrhage cases encountered. However this series represents the largest to date and supports previously published findings.…”

Section: E L a Y E D H A E M O R R H A G E A F T E R L A P A R O S mentioning

confidence: 99%

“…Renal artery pseudoaneurysm and AVF causing renal haemorrhage are well documented and are often reported after renal biopsy, blunt and penetrating renal trauma, renal transplantation, and are found in 1.2% of cases after percutaneous renal surgery [12,[24][25][26][27]. After OPN, a large series by Albani and Novick [28] showed that three out of 698 patients (0.4%) were found to have a RAP.…”

Section: Gross Hematuria ≥ 7 Daysmentioning

confidence: 99%

Delayed haemorrhage after laparoscopic partial nephrectomy: frequency and angiographic findings

et al. 2010

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Study Type – Therapy (case series)  Level of Evidence 4 What’s known on the subject? and What does the study add? Delayed haemorrhage has not been well defined in the literature, clinical presentation has not been well described and treatment algorithms are lacking. From our experience we have shown that patients presenting with delayed bleeding after laparoscopic partial nephrectomy will need definitive rather than conservative treatment and angiographic findings demonstrate definitive lesions in all cases. Potential benefits include faster diagnosis and initiation of definitive treatment (angiography with embolization), avoiding repeat computed tomography imaging as it adds little in such patients and reducing need for prolonged hospitalization. OBJECTIVES • To determine the frequency of delayed postoperative haemorrhage requiring selective angioembolization (SAE) after laparoscopic partial nephrectomy (LPN). • To describe the clinical presentation and characterize the angiographic findings encountered in this setting. PATIENTS AND METHODS • Prospective data from 640 LPNs performed between August 1993 and May 2009 were retrospectively analyzed, from which patients with delayed postoperative haemorrhage (defined as ‘gross haematuria ≥7 days postoperatively that persists for more than 24 h’) and requiring SAE were identified. • Clinicopathological, preoperative and perioperative factors were reviewed. • Selective catheterization and angiography of the renal artery was performed for persistent gross haematuria and for haemodynamic instability associated with a significant drop in haematocrit level. • Arteries feeding the bleeding site were identified and embolized with endovascular coils. RESULTS • Patients presented with delayed haemorrhage between 7 and 30 days after surgery. SAE was required in 13 patients (2%) for delayed postoperative bleeding. • Of the 640 LPNs, 68 (10.6%) were performed without hilar occlusion (‘off‐clamp’) of whom one (1.5%) had a delayed haemorrhage, which was successfully embolized. • For patients with and without delayed haemorrhage after LPN, the mean tumour size was 2.7 cm and 3.3 cm (P= 0.31), the mean warm ischaemia time was 28.2 min and 14.3 min (P < 0.001), and the mean estimated blood loss 403.8 mL and 308.2 mL (P= 0.26), respectively. • Percutaneous angiography showed renal artery pseudoaneurysm in 10 patients and arterial contrast extravasation in three patients, two of whom also had an arteriovenous fistula. • Following embolization, creatinine levels remained stable in all patients. CONCLUSIONS • Clinically significant delayed postoperative bleeding after LPN occurs in a small percentage of patients. • Angiography will accurately make the diagnosis of RAP or AVF and SAE is safe and effective procedure that allows for preservation of renal function.

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“…Under these conditions, and high pressure, blood leaks from the renal artery into a lower pressure system such as into the connective tissue space or a vein. [26] Richstone [27] reported that pseudoaneurysm was the most common arteriovenous malformation after sPNL with a 53% incidence based on angiographic assessments. El-Nahas [28] showed that arteriovenous fistula and pseudoaneurysm were one of the most common two findings associated with bleeding after PNL.…”

Section: Discussionmentioning

confidence: 99%

Is standard percutaneous nephrolithotomy still the standard treatment modality for renal stones less than three centimeters?

Sarılar

Özgör

Küçüktopçu

et al. 2017

Turkish Journal of Urology

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Objective: The aim of study was to compare the efficiency and safety of standard percutaneous nephrolithotomy (sPNL) and miniaturized percutaneous nephrolithotomy (mPNL) in lower calyx and/or pelvic stones smaller than three centimeters. Material and methods:From October 2010 to August 2015, 108 mPNL and 176 sPNL procedures were performed for renal stones smaller than three cm and located in the lower calyx and/or renal pelvis. All patients were evaluated preoperatively with intravenous pyelography and/or computed tomography. Intraoperative parameters, post-operative results and complications were recorded. Postoperative success was defined as complete stone clearance and/or clinically insignificant residual fragments at 3 rd month.Results: Preoperative characteristics were similar between sPNL and mPNL groups except previous renal stone operation history and gender. The mean operation time was significantly shorter in the sPNL group (p<0.001). The mean hemoglobin drop was significantly less in the mPNL group (p= 0.001), we found a 1.27±1.4 and 0.5±1.3 decrease in mean hemoglobin levels (mg/dL) in the sPNL and mPNL groups, respectively. Transfusion rate was 1.9% in mPNL and 5.6% in sPNL groups, and the difference was statistically significant (p=0.048). Only one patient in the sPNL group needed angiography and embolization. Postoperative JJ stent insertion rate was significantly higher in the mPNL group (p= 0.03). Conclusion:Both sPNL and mPNL are safe and effective surgical procedures for lower calyx and/or pelvis stones smaller than 3 cm. However, use of smaller caliber instruments was associated with a lesser hemoglobin drop and need for transfusion.

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1688: Hemorrhage Following Percutaneous Renal Surgery: Characterization of Angiographic Findings

Cited by 9 publications

References 0 publications

Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

Endovascular management of iatrogenic renal arterial lesions and clinical outcomes

Delayed haemorrhage after laparoscopic partial nephrectomy: frequency and angiographic findings

Is standard percutaneous nephrolithotomy still the standard treatment modality for renal stones less than three centimeters?

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