Contemporary Comparison of Surgical and Interventional Arteriography Management of Blunt Renal Injury

Sarani, Babak; Powell, Eleanor A.; Taddeo, Joseph; Carr, B.C.; Patel, Aalpen A.; Seamon, Mark J.; Wobb, Jessica; Sims, Carrie A.; Pascual, José L.; Schwab, C. William

doi:10.1016/j.jvir.2011.01.444

Cited by 34 publications

(22 citation statements)

References 13 publications

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“…Almost 32% of blunt renal injuries with arterial contrast extravasation on CT-scan have negative angiography [182]; these cases can be successfully managed without AE [182]. Overall AE success rate in blunt renal trauma ranges from 63% to 100% [135, 162, 181, 185, 188, 189, 194–200]. In case of need for a repeat AE, the success rate is similar to those seen in initial AE, so re-interventions are justified when indicated by the clinical course [185].…”

Section: Methodsmentioning

confidence: 99%

Kidney and uro-trauma: WSES-AAST guidelines

et al. 2019

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Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard. As with all traumatic conditions, the management of urogenital trauma should be multidisciplinary including urologists, interventional radiologists, and trauma surgeons, as well as emergency and ICU physicians.

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Section: Methodsmentioning

confidence: 99%

Kidney and uro-trauma: WSES-AAST guidelines

et al. 2019

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“…Renal artery embolisation is a less invasive treatment option than surgical intervention, providing a high renal salvage rate with lower complication rates and reduced length of hospital stay compared with surgical intervention. 15 In accordance with this, guidelines on urological trauma produced by the European Association of Urology (EAU) recommend that haemodynamically stable patients with renal injury of grade III or higher and active bleeding should be considered for formal angiography followed by embolisation. 2 …”

Section: Comparison Of Radiological Intervention In Similar Renal Tramentioning

confidence: 99%

Renal injury management in an urban trauma centre and implications for urological training

McPhee¹,

Arumainayagam²,

Clark

et al. 2015

annals

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INTRODUCTION The aim of this study was to analyse the treatment and management of renal injury patients presenting to our major trauma unit to determine the likelihood of patients needing immediate nephrectomy. METHODS The Trauma Audit and Research Network (TARN) database was used to review trauma cases presenting to our department between February 2009 and September 2013. Demographic data, mechanism and severity of injury, grade of renal trauma, management and 30-day outcome were determined from TARN data, electronic patient records and imaging. RESULTS There were a total of 1,856 trauma cases, of which 36 patients (1.9%) had a renal injury. In this group, the median age was 28 years (range: 16-92 years), with 28 patients (78%) having blunt renal trauma and 8 (22%) penetrating renal trauma. The most common cause for blunt renal trauma was road traffic accidents. Renal trauma cases were stratified into American Association for the Surgery of Trauma (AAST) grades (grade I: 19%, grade II: 22%, grade III: 28%, grade IV: 28%, grade V: 0%). All patients with grade I and II injuries were treated conservatively. There were three patients (1 with grade III and 2 with grade IV renal injuries) who underwent radiological embolisation. One of these patients went on to have a delayed nephrectomy owing to unsuccessful embolisation. CONCLUSIONS Trauma patients rarely require emergency nephrectomy. Radiological selective embolisation provides a good interventional option in cases of active bleeding from renal injury in haemodynamically stable patients. This has implications for trauma care and how surgical cover is provided for the rare event of nephrectomy.

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“…In all, 11 retrospective cohort studies that described the management of grade IV blunt renal trauma were finally included (Table 1). 2,[17][18][19][20][21][22][23][24][25][26] The inclusion criteria were as follows: 1 Participants (intervention and comparison). Studies reported on the management of grade IV blunt renal traumas involved a total of 703 adult patients, of whom 611 were treated using the conservative approach and 92 using the surgical approach.…”

Section: Resultsmentioning

confidence: 99%

Management of grade IV blunt renal trauma in adults: Systematic review and meta-analysis

Bramono¹,

Irdam²,

Rodjani³

et al. 2019

msk

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Background: Irrespective of the high incidence of grade IV renal trauma, there is still an ongoing debate regarding the use of conservative and surgical approaches for its treatment. This study aimed to conduct pooled analyses of published studies that concluded evidences regarding the management of grade IV renal trauma. Methods: Published studies between 1995 and 2015 from Cochrane Library, EBSCO, Embase, ProQuest, PubMed, and Scopus were reviewed and pooled analysis of eligible studies was conducted using random effects model. Heterogeneity was presented with I 2 and p value. Results: Eleven studies reporting on 703 adults were included in the analysis. Conservative approach was used in 611 patients (conservative group) and surgical approach in 92 patients (surgical group); success rate and morbidity were comparable between the groups (risk ratio (RR): 1.15, 95% confidence interval (CI): 0.72-1.83; RR: 0.77, 95% CI: 0.27-2.21, respectively). The trend of mortality was higher in the surgical group than the conservative group. Conclusions: A comparable success rate was observed between the groups. Mortality was higher in the surgical group than the conservative group. As advocated by many guidelines, conservative management may decrease unnecessary exploration, which can ultimately reduce reconstruction and/or nephrectomy rate without causing morbidity or mortality.

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Contemporary Comparison of Surgical and Interventional Arteriography Management of Blunt Renal Injury

Cited by 34 publications

References 13 publications

Kidney and uro-trauma: WSES-AAST guidelines

Kidney and uro-trauma: WSES-AAST guidelines

Renal injury management in an urban trauma centre and implications for urological training

Management of grade IV blunt renal trauma in adults: Systematic review and meta-analysis

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