Angiographic management of percutaneous renal procedure‐related bleeding: A single‐center experience

Abstract

Objectives To present the radiological and clinical results of transcatheter arterial embolization in patients with active bleeding after percutaneous renal procedures. Methods A total of 79 consecutive patients who underwent angiography for percutaneous renal procedure‐related bleeding were included in the present retrospective analysis. Patient characteristics, angiographic management and clinical outcomes were analyzed. Results On angiography, bleeding foci were observed in 81.0% of the patients (64/79), all of whom underwent transcatheter arterial embolization. Among the 15 patients (19.0%) with negative angiographic findings, empirical transcatheter arterial embolization was carried out in six patients (40.0%). The technical success rate in 64 patients with positive angiographic findings was 100%, and the clinical success rate in 70 patients who underwent transcatheter arterial embolization was 85.7% (60/70). A total of 14.3% (10/70) of patients with clinical failure underwent repeat transcatheter arterial embolization and all achieved clinical recovery. There were no major complications. There was no statistical difference in estimated glomerular filtration rate values before the percutaneous renal procedure and those measured 7 days after transcatheter arterial embolization (43.4 ± 24.4 to 44.6 ± 25.1 mL/min/1.73 m2; P = 0.189). Clinical failure was not associated with age, sex, type of renal procedures, bleeding tendency, presence of active bleeding on angiography, latency time and embolic agents used (P > 0.05). Conclusions Transcatheter arterial embolization is a safe and effective method of treating percutaneous renal procedure‐related bleeding without renal function deterioration.

Editorial Comment to Angiographic management of percutaneous renal procedure‐related bleeding: A single‐center experience

“…In the present study, Choi et al . reported the radiological and clinical results of TAE including a super‐selective technique used in patients with active bleeding after the percutaneous renal procedure . Consistent with similar reports, they concluded that TAE is a safe and effective method of treating bleeding related to percutaneous renal procedures …”

“…Interestingly, although previous studies on this topic have reported similar conclusions, the sample size of the present study was relatively large compared with that of the other studies, which is the strength of this study . The current report also includes cases of iatrogenic renal bleeding as opposed to accidental renal injury; therefore, data were available before renal bleeding and after TAE, allowing the authors to evaluate the chronological changes in renal function . There was no statistical difference in the estimated glomerular filtration rate from before the renal procedure to 7 days after TAE with the super‐selective technique, although renal function decreased at 1 or 3 days after TAE in some cases, probably because of damage from the bleeding rather than the TAE itself.…”

“…Given that 8.3% of all bleeding was reported to be derived from sites other than the renal artery, the possibility of extrarenal bleeding should be considered based on the route of puncture . Finally, although all cases of renal bleeding were controlled, it was notable that repeat TAEs were required in 10 cases . The risk factors for repeated TAE have been reported to be multiple percutaneous access sites and the presence of more than two bleeding sites on renal angiography, but no significant factors were reported in this study …”

“…There was no statistical difference in the estimated glomerular filtration rate from before the renal procedure to 7 days after TAE with the super‐selective technique, although renal function decreased at 1 or 3 days after TAE in some cases, probably because of damage from the bleeding rather than the TAE itself. Indeed, the results indicate that renal function after renal trauma due to TAE would recover without delay in most cases; although the numbers will be smaller, we should remain vigilant for cases in which renal function does not recover. Given that 8.3% of all bleeding was reported to be derived from sites other than the renal artery, the possibility of extrarenal bleeding should be considered based on the route of puncture .…”

“…Indeed, the results indicate that renal function after renal trauma due to TAE would recover without delay in most cases; although the numbers will be smaller, we should remain vigilant for cases in which renal function does not recover. Given that 8.3% of all bleeding was reported to be derived from sites other than the renal artery, the possibility of extrarenal bleeding should be considered based on the route of puncture . Finally, although all cases of renal bleeding were controlled, it was notable that repeat TAEs were required in 10 cases .…”