Emergency Transcatheter Arterial Embolization for Acute Renal Hemorrhage

Wang, Hong Liang; Xu, Chun Yang; Wang, Hong‐Hui; Wei, Xu

doi:10.1097/md.0000000000001667

Cited by 32 publications

(24 citation statements)

References 18 publications

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“…The patients are recommended to be routinely sent to the observation room for careful surveillance at early postoperative period. RH should be alerted if the patient presents with progressively decrease of hemoglobin, hypotension, tachycardia and acute ipsilateral abdominal/flank pain [ 6 , 14 , 15 ]. Rapid diagnosis of RH relies on proper imaging.…”

Section: Discussionmentioning

confidence: 99%

Unexpected renal hemorrhage after endovascular repair of complicated type B aortic dissection: two cases report

et al. 2018

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BackgroundThoracic endovascular aortic repair (TEVAR) is the therapeutic choice for type B aortic dissection. One of the most unfavored complications of this procedure is hemorrhage, which has a low incidence but high mortality. Renal hemorrhage (RH) after endovascular aortic repair has been rarely reported. We presented two cases of unexpected RH after TEVAR for complicated type B aortic dissection, and the potential causes, diagnosis and therapeutic management were discussed.Case presentationA 67-year-old female developed hypotension and progressively decrease of hemoglobin within 5 h after TEVAR for acute complicated type B dissection. Bedside ultrasonography and abdominal computed tomography angiography revealed a massive right perinephric hematoma. The right renal angiography detected multiple tortuous vascular branches with diffuse perinephric bleeding. The main trunk of right renal artery was embolized. The patient recovered uneventfully and presented with normal renal function 6 months later. Another patient was a 69-year-old male who was admitted for endovascular repair of a chronic complicated type B aortic dissection. The patient presented with hemodynamic instability early after TEVAR. Bedside ultrasonography showed a giant left retroperitoneal hematoma. The abdominal angiography revealed two active bleeding sits located in the distal branches of left renal artery. A super-selective embolization of the two arteries was performed, however the patient developed abdominal compartment syndrome and died of multiple organ failure.ConclusionsUnexpected RH after endovascular repair of aortic dissection might be associated with iatrogenic and idiopathic factors. Close surveillance and clinician’s awareness of this rare complication is crucial for accurate and prompt diagnosis. Renal angiography and subsequent selective embolization of bleeding vessels are effective interventions for treating this fatal condition.Electronic supplementary materialThe online version of this article (10.1186/s12893-018-0440-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Unexpected renal hemorrhage after endovascular repair of complicated type B aortic dissection: two cases report

et al. 2018

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“…1 Gradually, with advances in studies, trans-catheter arterial embolization (TAE) has been widely accepted, with the advantages of minimal invasiveness and a high success rate, as one of the most effective treatment options for acute RH. [3][4][5] In clinical settings, acute RH patients sometimes present with a coagulopathic condition, and a worse outcome has been proven in these patients than in those without coagulopathy. 6 MacLeod et al 7 commented that coagulopathy is an independent predictor of mortality even in the presence of other risk factors.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter Arterial Embolization with N-butyl-2 Cyanoacrylate Glubrans 2 for the Treatment of Acute Renal Hemorrhage Under Coagulopathic Condition

Gong¹,

He²,

Zhao³

et al. 2020

Preprint

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Background:The efficacy and safety of transcatheter arterial embolization (TAE) using the N-butyl-2 cyanoacrylate (NBCA) Glubran2 in the treatment of acute renal hemorrhage (RH) under coagulopathic conditionsarestill no consensus.Methods: Between February 2014 and June 2019, 8 patients underwent TAE with the NBCA Glubran2 for acute RH under coagulopathic conditions. Coagulopathy was defined as abnormal values of prothrombin time and activated partial thromboplastin time and/or a reduced platelet count.Angiograms and medical records were retrospectively reviewed to determine technical/clinical success, complications and recurrent hemorrhage after TAE, and follow-up outcomes were assessed.Results: Of note, one patient presented with severe coagulopathy, and three presented with severe RH and hemodynamic instability. The NBCA Glubran2 was employed as a sole embolic material in sixpatients. In the remaining two patients, it was employed for secondary embolization.Under coagulopathic conditions, due to the use of the NBCA Glubran2, both technical success and clinical success for acute RH were achieved in all patients. Duringa mean follow-up time of 30.1 months (range, 3-84 months), neither persistent nor recurrent active hemorrhage required repeat endovascular or surgical treatment for hemostasis. No Glubran2related complications occurred mid-TAE pro-cedure. In addition, renal function information was available for all patients, and there was no significant difference between the serum creatinine levels [(83.8 ± 15.5) vs (85.8 ± 32.2) μmol/L] before and one week after Glubran2 embolization (p=0.89; CI, -34.5 to 30.5).Conclusions: The present findings suggest that TAE with the NBCA Glubran2 may be a safe alternative treatment for the management of RH under coagulopathic conditions. In particular, this method appears to be a potentially attractive alternative when con-ventional embolic materials fail in patients with ongoing hemodynamic instability or even under severe coagulopathic conditions.

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“…The rate of minor and major complications grouped together is 10%; considering major hemorrhages only, those requiring blood transfusions occur in up to 4% of the cases while those requiring arterial embolization occur in up to 1% (Pabon-Ramos et al 2016). Nephrectomy is reserved only for the cases in which the minimally invasive endovascular treatment fails (Summerton et al 2012); actually the technical success of transarterial embolization of iatrogenic renal hemorrhages occurring during nephrostomic procedures is high (Jinga et al 2013;Kervancioglu et al 2014;Wang et al 2015); multiple embolizing agents have been reported, mainly coils/microcoils, gelatin sponge and particles.…”

Section: Introductionmentioning

confidence: 99%

MVP (Micro Vascular Plug®) embolization of severe renal hemorrhages after nephrostomic tube placement

et al. 2019

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Background: We report our experience in managing iatrogenic renal bleedings after nephrostomic procedures by transarterial embolization using Micro Vascular Plug (MVP) (Medtronic, USA) as single or complementary embolization device with parenchimal sparing. Materials and methods: Five patients have been treated in a single center with transarterial embolization because of renal hemorrhages occurring after positioning of nephrostomic drainages. All patients presented with back pain, severe hematuria and/or bright red blood into the nephrostomic bag, with fall in hemoglobin value. After contrast enhanced CT scan confirming arterial active bleeding, rescue embolization was performed using MVP. The renal parenchimal loss was estimated on final postembolization DSA. Creatinine values were monitored before and after the procedure. Results: Technical and clinical successes were obtained in all patients. Two patients presented with extraluminal blush, one with multiple pseudoaneurysms, one with pseudoaneurysm with arterovenous fistula, one with extraluminal blush with arterovenous fistula. MVP models were choosen oversized because of vasospasm that would underestimate the effective caliber of target vessel; MVP 3Q and MVP 7Q were adopted in one patient each, while MVP 5Q was released in three cases. MVP was the sole embolizing agent in four patients; in one patient, MVP was employed after microcoils failed to obtain complete embolization. The percentage of renal parenchimal lost was lower than 20%; no increase in Creatinine values was detected at dismission. Conclusions: According to proposed data, MVP seems to be a safe, effective and fast embolizing device that interventionalists could consider when facing renal bleedings, even as sole agent.

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Emergency Transcatheter Arterial Embolization for Acute Renal Hemorrhage

Cited by 32 publications

References 18 publications

Unexpected renal hemorrhage after endovascular repair of complicated type B aortic dissection: two cases report

Unexpected renal hemorrhage after endovascular repair of complicated type B aortic dissection: two cases report

Transcatheter Arterial Embolization with N-butyl-2 Cyanoacrylate Glubrans 2 for the Treatment of Acute Renal Hemorrhage Under Coagulopathic Condition

MVP (Micro Vascular Plug®) embolization of severe renal hemorrhages after nephrostomic tube placement

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