Clinical efficacy and safety of transcatheter embolization for vascular complications after percutaneous nephrolithotomy.

Poyraz, Necdet; Balasar, Mehmet; Gökmen, İbrahim Erdem; Koç, Osman; Sönmez, Mehmet Giray; Aydın, Arif; Göğer, Yunus Emre; Öztürk, Ahmet

doi:10.5114/wiitm.2017.69108

Cited by 11 publications

(13 citation statements)

References 19 publications

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“…In this study, 46 patients with positive angiographic findings underwent SRAE and underwent renal artery angiography again after embolization, showing complete occlusion of the target artery, with a technical success rate of 100%. Meanwhile, the clinical success rate of this study was also 100%, which was significantly better than previous studies (5,7,18). Careful and meticulous angiography and reasonable selection of embolization materials based on the results of angiography may explain the high technical and clinical success rates in the present study.…”

Section: Discussioncontrasting

confidence: 43%

“…Hemorrhage is the most serious and dangerous complication of PCNL (3,4). Although it is usually self-limited and can be controlled conservatively (5,6), severe hemorrhage is still a troublesome problem, occurring in 0.3-4.7% of cases and requiring expeditious attention (1,7,8). In these patients, hemostasis by surgical exploration may lead to nephrectomy.…”

Section: Introductionmentioning

confidence: 99%

“…Since 1970's, percutaneous renal arterial embolization has been used to control renal bleeding (10). It has been reported that up to 20% of patients with hemorrhage after PCNL require transfusion, while <1% require angiographic embolization (5,(11)(12)(13). Recently, with the introduction of new interventional devices and embolization materials, embolization technology has been further developed (14).…”

Section: Introductionmentioning

confidence: 99%

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Superselective Renal Artery Embolization Management of Post-percutaneous Nephrolithotomy Hemorrhage and Its Methods

et al. 2020

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Objective: The purpose of this study was to evaluate the therapeutic efficacy and safety of superselective renal arterial embolization (SRAE) in the treatment of patients with renal hemorrhage after percutaneous nephroscopy (PCNL). In addition, embolization techniques and embolization materials during operation were also worthy of further discussion.Methods: From February 2015 to December 2019, clinical data of 49 consecutive patients with renal hemorrhage after PCNL were retrospectively analyzed. Demographic and clinical data of patients were recorded, changes in serum creatinine values were analyzed, and the safety and efficacy of TAE were evaluated. Clinical experience was also recorded.Results: A total of 49 patients underwent angiography, of which 46 patients received SRAE due to positive hemorrhagic foci detected by angiography, and the technical success rate of 46 patients was 100%. Among the three patients who did not receive embolization, one patient underwent nephrectomy, and two patients improved with conservative treatment, with a clinical success rate of 98%. There was no statistically significant difference between serum creatinine before PCNL and 7 days after SRAE (101.6 ± 36.5 to 100.5 ± 27.1 μmol/L; P = 0.634), and no significant change was observed in serum creatinine at the last follow-up (99.4 ± 34 μmol/L, P = 0.076). No major complications occurred after embolization.Conclusions: SRAE is safe and effective in patients with renal hemorrhage after PCNL. The experience of interventional therapy and the choice of embolization materials in this study may provide certain benefits for the treatment of patients with renal hemorrhage after PCNL.

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Section: Discussioncontrasting

confidence: 43%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Superselective Renal Artery Embolization Management of Post-percutaneous Nephrolithotomy Hemorrhage and Its Methods

et al. 2020

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“…In most patients, post-PCNL hemorrhage could be controlled by conservative therapy. However, TAE has been an established therapy for severe, persistent, or intermittent hemorrhage after PCNL that cannot be stopped by conservative treatment [17, 18]. In previous literatures, large stone burdens with multiple punctures, lower renal puncture site, stone number and types, history of ipsilateral renal stone surgery, and occurrence of intraoperative pelvicalyceal perforation have been demonstrated as the risk factors for severe post-PCNL hemorrhage [19–22].…”

Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Transcatheter Arterial Embolization to Treat Renal Hemorrhage after Percutaneous Nephrolithotomy

Luo

et al. 2019

BioMed Research International

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Purpose. The aim of this study was to evaluate the safety and efficacy of transcatheter arterial embolization (TAE) in patients with renal hemorrhage after percutaneous nephrolithotomy (PCNL) and evaluate the risk factors that may result in severe bleeding requiring TAE. Methods. We retrospectively reviewed 121 patients with post-PCNL renal hemorrhage. Thirty-two patients receiving endovascular embolization were compared with 89 patients only receiving conservative treatment. The demographic and clinical data were recorded and compared between the two groups. The values of estimated glomerular filtration rate (eGFR) and serum creatinine (SCr) were recorded preoperatively, postoperatively, and at last follow-up and analyzed to evaluate the safety and efficiency of TAE. Results. The successful hemostasis rate of conservative therapy was 73.6% (89/121) and that of TAE was 100% (32/32). SCr and eGFR were not significantly different before PCNL and after the last follow-up of TAE (SCr: 0.95 vs. 0.95 mg/dl, P=0.857; eGFR: 86.77 vs. 86.18 ml/min/1.73m2, P=0.715). The univariate analysis demonstrated that advanced age, urinary tract infection, and diabetes mellitus were significantly associated with severe bleeding during PCNL. Multivariate analysis further identified that diabetes mellitus was an independent risk factor for severe bleeding needing TAE [odds ratio (OR): 3.778, 95% confidence interval (CI):1.276-11.190, and P=0.016]. Conclusion. TAE is a safe and effective procedure to treat renal hemorrhage that cannot be resisted by conservative treatment after PCNL. Diabetes mellitus was associated with high risks of severe bleeding needing TAE after PCNL.

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“…Post-PCNL bleeding is usually caused by pseudoaneurysm, AVF, and arterial laceration in previous related studies. When renal arterial bleeding does occur, blood from the injured artery can leak freely due to the high pressure, drain into the injured adjacent vein resulting in AVF, or into renal parenchyma or hilar areolar tissue resulting in pseudoaneurysm 5,6,19 . However, in our cases, these life-threatening hemorrhages are usually caused by arterial laceration (28, 62.20%) and AVF (7, 15.60%).…”

Section: Discussionmentioning

confidence: 99%

Rate of hemoglobin decline: indication optimization of transcatheter angiographic embolization after PCNL

Xiao

Xiang

et al. 2020

Preprint

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Background To evaluate the clinical characteristics and angiographic features of transcatheter angiographic embolization (TAE) in patients with active bleeding after percutaneous nephrolithotomy (PCNL).Methods Between October 2009 and April 2018, 45 patients who underwent TAE for hemorrhage control after PCNL were reviewed retrospectively. Patient clinical characteristics and angiographic features of TAE were analyzed.Results Of the 3148 patients, 45 (1.4%), including 35 men (77.78%) and 10 women (22.22%), were treated with TAE after PCNL. Ten patients (22.22%) had a history of kidney surgery. The interval from the bleeding episode to TAE was 3 days (range, 1–6 days). In addition, 27 (60.0%) and 18 patients (40.0%) experienced sudden onset of bleeding and delayed bleeding, respectively. Arterial laceration, arteriovenous fistula, and negative angiographic finding was found in 28 (62.2%), 7 (15.6%), and 10 patients (22.2%), respectively. Thirty-five patients (92.1%) achieved primary clinical success. The median corrected hemoglobin decrease from bleeding episode to TAE was 52 g/L (25.25, 71.00). The median corrected hemoglobin decrease rate from bleeding episode to TAE was 13.11 g/L d (5.60, 26.12). The hemoglobin decrease from bleeding episode to TAE was lesser in negative angiographic patients (28.50 (10.75,51.25) g/L VS 53.7 (35.0,73.13) g/L) than in positive angiographic patients (P<0.05).Conclusion TAE is a safe and effective treatment for patients with post-PCNL bleeding. TAE should be performed for post-PCNL bleeding in patients with hemoglobin decrease of >25 g/L or hemoglobin decrease rate of >5.5 g/L·d following conservative management.

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Clinical efficacy and safety of transcatheter embolization for vascular complications after percutaneous nephrolithotomy.

Cited by 11 publications

References 19 publications

Superselective Renal Artery Embolization Management of Post-percutaneous Nephrolithotomy Hemorrhage and Its Methods

Superselective Renal Artery Embolization Management of Post-percutaneous Nephrolithotomy Hemorrhage and Its Methods

The Efficacy and Safety of Transcatheter Arterial Embolization to Treat Renal Hemorrhage after Percutaneous Nephrolithotomy

Rate of hemoglobin decline: indication optimization of transcatheter angiographic embolization after PCNL

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