Clinical outcomes of endovascularly managed iatrogenic renal hemorrhages

Chiramel, George Koshy; Keshava, Shyamkumar Nidugala; Moses, Vinu; Kekre, Nitin S; Tamilarasi, V; Devasia, Antony

doi:10.4103/0971-3026.169454

Cited by 11 publications

(9 citation statements)

References 27 publications

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“…As reported by Chiramel et al, embolization was performed in 53 patients with the manifestation of RAP or RAVF in the first renal angiography, of which 38 (71.7%) showed clinical resolution. [ 17 ] Incomplete embolization with coils may explain the relatively lower resolution rate compared with that in our study. In another study including 21 patients receiving TAE for iatrogenic arterial kidney bleeding, Ierardi et al reported that the technical success rate was 100% and overall clinical success rate was 95%, which was in agreement with our results.…”

Section: Discussioncontrasting

confidence: 68%

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Management of iatrogenic renal arteriovenous fistula and renal arterial pseudoaneurysm by transarterial embolization

et al. 2017

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The purpose of this study was to evaluate the efficacy and safety of transarterial embolization (TAE) for iatrogenic renal arterial pseudoaneurysm and arteriovenous fistula at our center.Our retrospective analysis included 27 patients who received TAE for iatrogenic renal arterial pseudoaneurysm and arteriovenous fistula between January 2006 and January 2016. Data on demographics, type of minimally invasive renal procedures, clinical manifestation, imaging features, embolization procedure, and perioperative details were collected. The technical and clinical success rates were analyzed. Furthermore, the changes in serum creatinine and eGFR before and after embolization were recorded and compared by t test.The median time between iatrogenic renal injury and TAE was 3 days (range, 0–110 days), with most patients (24/27, 88.9%) receiving TAE within 14 days. Only 1 patient was diagnosed with renal artery pseudoaneurysm 110 days after laproscopic partial nephrectomy. The technical and clinical success rates were 100% and 96.3%, respectively, with 1 patient requiring a second embolotherapy at the third postoperative day. No other patient required additional endovascular or surgical intervention due to recurrent hemorrhage. The mean serum creatinine before TAE was 92.8 ± 25.3 μmol/L and after TAE, 96.1 ± 27.7 μmol/L (P = .095). The eGFR of pre- and postembolization was 75.2 ± 26.5 mL/min/1.73 m2 and 72.5 ± 26.2 mL/min/1.73 m2 (P = .16). No severe complications were observed during follow-up.This retrospective review demonstrated that TAE for the treatment of iatrogenic renal artery pseudoaneurysm and/or arteriovenous fistula was safe and associated with high technical and clinical success rate.

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Section: Discussioncontrasting

confidence: 68%

“…[ 7 ] In another retrospective series of patients with iatrogenic renal hemorrhages, no significant change in serum creatinine level was observed after embolotherapy. [ 17 ]…”

Section: Discussionmentioning

confidence: 99%

Management of iatrogenic renal arteriovenous fistula and renal arterial pseudoaneurysm by transarterial embolization

et al. 2017

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“…Technical success rates of 98%–100% and clinical success rates of 83%–98% for endovascular management of renal vascular injuries have been reported, similar to ours. [ 13 14 15 ] Endovascular management has high success rates with fewer complications, rapid recovery, and a better safety profile as compared to surgery. Complications can be due to access site aneurysm, hematoma or dissection, renal artery dissection or perforation, non-target embolization, and rarely significant parenchymal loss causing hypertension or even renal failure.…”

Section: Discussionmentioning

confidence: 99%

Interventional radiology in the management of renal vascular injury: A prospective study

et al. 2020

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Introduction: Endovascular and percutaneous interventions are promising alternatives to surgical management of traumatic renal injuries and often avert the need for nephrectomies. In this study, we aimed to evaluate the role of interventional radiology and angiographic interventions in the management of renal vascular injury. Materials and Methods: Our prospective study was performed over a period of 6 months. Twenty-five patients who presented with either persistent hematuria or hemodynamic instability after traumatic or iatrogenic renal injuries were selected. Angiographic embolization using varying combinations of coils, glue, and Gelfoam ® was performed to address the vascular injuries, either directly in hemodynamically unstable patients or after preprocedural imaging in hemodynamically stable patients. Patients were then followed up till discharge from hospital 48 h later and at 2 weeks and 4 weeks postprocedure for any recurrence of hematuria or hemodynamic instability. Technical and clinical success rates were calculated using descriptive statistics. Results: Pseudoaneurysms were the most common form of arterial injury (22 cases), followed by arteriovenous fistula (8) and active extravasation (5). Segmental arteries are the most commonly involved (12 cases), followed by interlobar (9) and arcuate (3) arteries. Gelfoam ® was used in five patients with active contrast extravasation and was 100% effective in arresting active bleeding. Coiling alone had a 79.16% technical success rate in management, while additional use of glue in four failed cases led to a 95.83% technical success rate in the first attempt. The ultimate technical and clinical success rate of interventional radiology in renal trauma management (after the second attempt in one failed case) was 100%. Conclusion: Endovascular management is an effective and safe alternative to surgical management of both iatrogenic and accidental renal vascular injuries.

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“…Alternative follow-up investigations could include ultrasound with colour doppler (might show active bleed into a haematoma) or CT-angio to detect the cause of the continual bleed. 17 Selective RAE will also infarct areas of healthy renal tissue. However, our review did not show a significant loss of global renal function (based on serum creatinine levels).…”

Section: Discussionmentioning

confidence: 99%

Renal artery embolisation: indications and utilisation at Tygerberg Hospital

Pretorius¹,

Vlok²,

Merwe³

et al. 2019

S. Afr. j. surg.

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Background: To evaluate the indications, efficacy and outcomes of endovascular renal artery embolisation (RAE) in the management of renal haemorrhage, specifically in cases of non-iatrogenic origin. Methods: This is a retrospective case note review of 92 patients who underwent RAE in the period from August 1999 to August 2014 at Tygerberg Hospital. Results: Renal artery embolisation was performed in a total of 92 patients. The indication was traumatic renal injury in 60 patients (65.2%), with mean age 28.2 years. The mechanism of injury was stabbing (55.4%), blunt trauma (7.6%) and gunshot (2.2%). Digital subtraction angiography (DSA) showed pseudo-aneurysm in 32.6%, arteriovenous fistula in 19.6% and segmental artery injury in 13%. Embolisation success: 85% after one, 88.9% after a second attempt, with an overall success rate of 98.3% after two attempts. In 20 of the 92 patients (mean age 50.2 years) the indication was malignancy (21.7%). Other cases included iatrogenic haematuria (4.3%) and angiomyolipoma (3.3%). Embolisation was repeated in 16.3%, with eventual success rate of 93.8%. Post-embolisation syndrome was the most common complication, seen in 9.8% of all cases. Of the 9 patients who returned for follow-up with renogram imaging, 4 had a differential function of > 20% of the embolised kidney. Conclusion:Renal artery embolisation remains a very successful method of managing renal haemorrhage at this hospital, whether this results from trauma, malignancy, iatrogenic or other causes.

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Clinical outcomes of endovascularly managed iatrogenic renal hemorrhages

Cited by 11 publications

References 27 publications

Management of iatrogenic renal arteriovenous fistula and renal arterial pseudoaneurysm by transarterial embolization

Management of iatrogenic renal arteriovenous fistula and renal arterial pseudoaneurysm by transarterial embolization

Interventional radiology in the management of renal vascular injury: A prospective study

Renal artery embolisation: indications and utilisation at Tygerberg Hospital

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